Issue: January 2013
November 01, 2012
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IOP reduction sustained after cataract surgery

Study results show that cataract surgery alone might be sufficient to reduce IOP in most eyes with ocular hypertension and controlled glaucoma.

Issue: January 2013
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Cataract extraction without IOP-lowering medications yielded a significant, sustained reduction in pressure, according to data culled from the Ocular Hypertension Treatment Study.

Perspective from Thomas W. Samuelson, MD, MD

The results underscored the efficacy of cataract surgery alone in lowering IOP in some eyes, Steven L. Mansberger, MD, MPH, the corresponding study author, told Ocular Surgery News.

“The point of our paper is that some patients may have enough IOP lowering with cataract surgery alone, especially [those] with ocular hypertension,” Mansberger said. “Those with well-controlled glaucoma, those who only have ocular hypertension or are glaucoma suspects, may only need cataract surgery alone to attain a lower intraocular pressure.”

The Ocular Hypertension Treatment Study (OHTS) included 1,636 patients. It was designed to gauge the safety and efficacy of IOP-lowering medication in preventing the onset of primary open-angle glaucoma in patients with elevated IOP. Patients were randomized to receive IOP-lowering medication or undergo observation.

The study was published in Ophthalmology.

Patients and protocols

Mansberger and colleagues included data from the observation group of the OHTS and excluded data from the medication group. Their comparative case series included 63 eyes of 42 patients who underwent cataract extraction. A control group comprised 743 eyes of 743 subjects who did not have cataract surgery.

Mean patient age was 64.1 years in the cataract surgery group and 55 years in the control group.

Steven L. Mansberger, MD

Steven L. Mansberger

The researchers determined a split date: a point at which cataract surgery was reported in the study group and a corresponding date in the control group.

IOP was measured up to three times before the split date and up to three times after the split date in both groups.

Mean preoperative IOP in the surgery group was 23.9 mm Hg. In the control group, mean IOP before the split date was 23.8 mm Hg.

Mean central corneal thickness was 584.7 µm in the study group and 574.3 µm in the control group.

“We don’t know why this difference occurred. Perhaps this represents a bias towards surgery in those with a thicker cornea because they had a higher pressure, and that encouraged them or their doctor to have cataract surgery,” Mansberger said. “However, it was only a 10-µm difference, so it’s really a small difference in terms of corneal thickness and could simply be a chance difference between the groups. Otherwise, the amount of IOP lowering should be valid since corneal thickness was not related to IOP lowering in our study.”

Results and conclusions

Study results showed that mean postoperative IOP in the surgery group was 19.8 mm Hg; the decrease was statistically significant (P < .001).

The average decrease in IOP after surgery was 16.5%; postoperative IOP was at least 20% lower than preoperative IOP in 39.7% of eyes.

In the surgery group, postoperative IOP was lower than preoperative IOP for at least 36 months.

Mean IOP in the control group was 23.8 mm Hg before the split date and 23.4 mm Hg after the split date; the decrease was not statistically significant.

The greatest reduction in postoperative IOP occurred in eyes with the highest preoperative IOP, Mansberger said.

“That was something shown by our paper and was in agreement with other people’s papers as well,” he said. “That was really the main factor associated with IOP lowering.”

Data on complications were not available, Mansberger said.

“If we had the ability to exclude those that may have had complications from cataract surgery, we may have had an even lower intraocular pressure. However, by presenting the data as an ‘intention-to-treat’ analysis, the results are more generalizable,” he said. – by Matt Hasson

Reference:
Mansberger SL, Gordon MA, Jampel H, et al. Reduction in intraocular pressure after cataract extraction: The Ocular Hypertension Treatment Study. Ophthalmology. 2012;119(9):1826-1831.
For more information:
Steven L. Mansberger, MD, MPH, can be reached at 1040 NW 22nd Avenue, Suite 200, Portland, OR 97210; 503-413-8202; fax: 503-413-6937; email: smansberger@deverseye.org.
Disclosure: Mansberger is a consultant for Alcon and Allergan and has received grant support from Devers Eye Institute and Merck.