Vitreous loss at cataract surgery adversely affects IOP control, despite modern technology

SAN DIEGO, Calif. — Even though surgeons have moved to less invasive cataract procedures, vitreous loss during cataract surgery continues to adversely influence postoperative IOP in glaucoma patients, according to a presentation here.

Abhay R. Vasavada, MS, FRCS, addressed new microsurgical techniques, which had not been previously considered in the literature, during the American Society of Cataract and Refractive Surgery meeting.

In a retrospective study, patients with primary open angle glaucoma from several hospitals in the United Kingdom were divided into three groups; group 1 included eyes with complicated phacoemulsification (ie, posterior capsular tear with vitreous loss), group 2 included the fellow eyes of those patients, and group 3 was eyes with uncomplicated phaco.

At the 12 month follow-up, investigators found no difference in IOP across the groups, according to Dr. Vasavada. However, when investigators considered the number of glaucoma medications per eye, they saw a significant increase in the mean number of medications used in group 1.

When phacoemulsification caused vitreous loss, 61% of patients required a greater number of glaucoma medications postop. Eyes in group 1 increased their number of medications by a mean of 0.78, and eyes in group 2 also showed a slow disease progression.

Eyes in group 3, in contrast, decreased their mean number of medications used postop, leading Dr. Vasavada to conclude that the surgical event itself — and specifically the vitreous loss — adversely affected glaucoma. Uncomplicated phaco, meanwhile, actually improved IOP control, he noted.