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Low baseline corneal hysteresis associated with reduced IOP after cataract surgery
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Patients without glaucoma who underwent cataract surgery with a low baseline corneal hysteresis had decreased postoperative intraocular pressure, according to a study published in the Journal of Cataract & Refractive Surgery.
“Although using a nonglaucomatous sample limits the applications of this study, we believe that it allowed us to show proof of the concept that [corneal hysteresis] CH is associated with IOP reduction from cataract extraction,” Madhvi Deol, BS, and colleagues wrote in their study. “The present study further shows the potential uses of CH in clinical and research settings.”
Deol and colleagues reviewed the charts of 39 patients (65 eyes) who were a mean of 70.8 years old and underwent phacoemulsification cataract extraction with posterior chamber intraocular lens implantation, according to the study. Patients were measured at 2 months to 4 months postoperatively and 10 months to 12 months postoperatively using the Ocular Response Analyzer (Reichert Inc., Buffalo, N.Y.).
They found that the mean values for IOP were 14.8 ± 3.5 mm Hg at baseline, 11.9 ± 3.4 mm Hg at 2-month to 4-month follow-up, and 12.6 ± 3.1 mm Hg at 12-month follow-up. After controlling for patient age, the baseline CH was significantly associated with the magnitude of IOP reduction at 10 months to 12 months, but not 2 months to 4 months, the authors said.
“We believe that the present study suggests that an understanding of the cornea’s biomechanics might aid clinicians in understanding which patients may or may not have an IOP reduction after cataract extraction,” they concluded. – by Jeffrey Craven
Disclosure: Radcliffe is a consultant for Reichert Technologies, Glaukos, Allergan, Alcon, Iridex, Merge Healthcare and Carl Zeiss Meditec AG, and is a speaker for Merck Pharmaceuticals.
Perspective
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Derek MacDonald, OD, FAAO
The landmark Ocular Hypertension Treatment Study changed the way we practice by demonstrating that central corneal thickness is a strong and independent risk factor for the development of open-angle glaucoma (Gordon and colleagues).
A number of recent investigations may be driving another paradigm shift by illuminating the critical role of corneal hysteresis (CH) in the onset and progression of open-angle glaucoma (OAG) and its response to treatment.
Grise-Dulac and colleagues, Congdon and colleagues, Medeiros and colleagues and others have shown low CH to be strongly correlated to glaucoma onset and progression (more so than central corneal thickness), particularly in the presence of elevated IOP. In demonstrating that baseline CH influences the magnitude of IOP reduction following cataract extraction, Deol and colleagues join Agarwal and colleagues and Hirneiss and colleagues, who found greater IOP reduction in patients with low CH following treatment with topical prostaglandins and selective laser trabeculoplasty.
Although much remains to be learned about CH, what we currently know suggests that it is poised to become another critical data point in assessment of risk, prediction of disease progression and response to treatment. In fact, as a dynamic corneal behavior (tending to increase as IOP decreases) rather than a static property, CH may join IOP as a future treatment co-target.
References:
Agarwal DR, et al. Br J Ophthalmol. 2012; 96:254–257.
Congdon NG, et al. Am J Ophthalmol. 2006;141:868–875.
Gordon MO, et al. Arch Ophthalmol. 2002;120(6):714-720.
Grise-Dulac A, et al. J Glaucoma. 2012;21:486–489.
Hirneiss C, et al. Graefes Arch Clin Exp Ophthalmol. 2013;251:2383–2388.
Medeiros FA, et al. Ophthalmology. 2013;120:1533–1540.
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