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Cataract surgery alone reduces IOP in pseudoexfoliation
In a study, more irrigation in cataract surgery was correlated with more pressure lowering.
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CHICAGO — Cataract surgery lowers IOP and, in some cases, “very effectively” lowers IOP in patients with pseudoexfoliation, a surgeon said at Glaucoma Subspecialty Day preceding the American Academy of Ophthalmology meeting.
“Pseudoexfoliation syndrome is the most common identifiable cause of open-angle glaucoma, and it is a terribly aggressive disease. It would be good if there was a way of managing this earlier on,” Karim F. Damji, MD, FRCSC, MBA, said.
According to Damji, many previous studies on the effects of cataract surgery on pseudoexfoliation syndrome have been retrospective, which led the Lindberg Society to do a prospective study.
Patients and methods
In the prospective study to determine IOP response to phacoemulsification in glaucoma patients with and without pseudoexfoliation, Damji and colleagues found a significant reduction in IOP in patients with pseudoexfoliation. The study included 183 patients who either underwent cataract surgery and who had pseudoexfoliation syndrome or were part of a control group.
“Our approach at present is, [in] those patients with no glaucoma or early glaucoma, we tend to do cataract [surgery] alone. If there is early or moderate glaucoma and pressure is not well controlled, we will add a microinvasive glaucoma surgery,” Damji said. “If it is advanced glaucoma or if the pressure is out of control, then we will go to phacotrabeculectomy.”
The surgical approach to patients with pseudoexfoliation is guided by open- or closed-angle glaucoma, stage of glaucoma, degree of IOP elevation, ocular and systematic factors, and patient and care partner preferences.
Postoperative outcomes
After a 6-month follow-up, researchers found that IOP had stabilized in all groups. Patients with exfoliation glaucoma had about a 4 mm Hg decrease in IOP, which remained stable for a few years, compared with a decrease of 2.75 mm Hg in patients with pseudoexfoliation syndrome with no evidence of glaucoma and about 1.5 mm Hg in patients with primary angle glaucoma with no evidence of pseudoexfoliation, Damji said.
“We measured irrigation fluid before and after surgery to get an idea of how much went through the eye in these various patients,” Damji said.
In the study, the pseudoexfoliation group received more irrigation fluid.
“There was an interesting correlation in the exfoliation patients overall. The greater the volume of irrigation fluid used at the time of surgery, the more pressure lowering we observed. A similar finding was not seen in the non-exfoliation patients,” Damji said.
Damji thinks that cataract surgery has a role in lowering IOP in patients with pseudoexfoliation syndrome, but he urges postoperative follow-up.
“Some patients will get an unpredictable pressure rise a couple years out. Patients need to be followed closely,” he said. – by Nhu Te
Reference:
Damji KF, et al. Br J Ophthalmol. 2006;doi:10.1136/bjo.2006.091447.For more information:
Karim F. Damji, MD, FRCSC, MBA, can be reached at the Department of Ophthalmology and Visual Sciences, University of Alberta, 2317, 10240 Kingsway Ave., Edmonton, AB T5H 3V9 Canada; 780-735-4200; email: kdamji@ualberta.ca.Disclosure: Damji has no relevant financial disclosures.