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Cataract surgery lowers IOP more in patients with higher pre-op IOP
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Patients with chronic angle-closure glaucoma and narrow angles may benefit greatly from cataract surgery, according to a study recently published in the Journal of Cataract & Refractive Surgery.
Brown and colleagues conducted a retrospective case series to assess changes in intraocular pressure in 56 patients with narrow angles or chronic angle-closure glaucoma (ACG) after cataract surgery.
Researchers reviewed charts, analyzing potential correlations between IOP and preoperative pressure, axial length and anterior chamber depth. They stratified the 83 eyes included in the study into four groups based on preoperative IOP.
Results showed that 88% of participants experienced a decrease in IOP with a mean reduction of 3.28 mm Hg, or 18%. They also indicated a significant correlation between IOP reduction and preoperative pressure; researchers noted that "the patients who may need pressure lowering the most may achieve the greatest IOP reduction after cataract surgery."
Eyes with a preoperative IOP of 15 mm Hg or less demonstrated a mean decrease of 1.4 mm Hg, the over-15 mm Hg to 18 mm Hg group demonstrated a mean decrease of 2.5 mm Hg, the over-18 mm Hg to 20 mm Hg group demonstrated a mean decrease of 4.6 mm Hg, and eyes with a preoperative IOP of more than 20 mm Hg demonstrated a mean decrease of 5.3 mm Hg.
"Cataract surgery plays an important role in the therapy for eyes with ACG," the authors concluded. "Patients with symptoms of cataract, elevated IOP and narrow or closed angles may benefit greatly from cataract surgery. For eyes with pressures greater than 20 mm Hg, cataract surgery may not only improve vision, it may also lower IOP to the same extent as adding a glaucoma eye drop."
Disclosure: The authors have no relevant financial disclosures.
Perspective
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Scott Anthony, OD, FAAO
Many patients who suffer from angle-closure glaucoma do not fully respond to laser peripheral iridotomy, which aims to alleviate underlying pupillary block. In cases where laser peripheral iridotomy treatment fails to adequately lower intraocular pressure, topical medications are typically employed to combat glaucoma.
This study helps define the effectiveness of cataract surgery as a therapeutic option for recalcitrant cases of angle-closure glaucoma. Conveniently, the IOP-lowering effect of cataract removal was more robust in angle-closure patients with a higher range of pressures.
As optometrists, we should be astute to the potential benefit of cataract surgery in our angle-closure patients, specifically those with visually significant cataracts and taking multiple topical medications.
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