This article is more than 5 years old. Information may no longer be current.
Phaco alone lowers IOP, reduces need for drops
Click Here to Manage Email Alerts
Phacoemulsification as a solo procedure lowers intraocular pressure and reduces patient dependency on glaucoma medications, according to researchers in the Journal of Glaucoma.
Researchers suggest that certain patient populations respond to phacoemulsification to a greater degree than others, but further work to identify the “high-responders” is necessary.
The retrospective review included 32 studies and 1,826 subjects with comorbid cataract and primary open-angle glaucoma (POAG) who underwent phacoemulsification (phaco) and its effect on IOP and the required amount of topical glaucoma medications.
Researchers found a 12%, 14%, 15% and 9% reduction in IOP from baseline at 6, 12, 24 and 36 months after phaco.
A mean reduction in glaucoma medications of 0.57, 0.47, 0.38 and 0.16 was noted per patient at 6, 12, 24 and 36 months after phaco, respectively.
The IOP-lowering effects appear to last at least 36 months, with gradual loss of the initial effect noted after 2 years, according to researchers.
“The decision to pursue trabeculectomy or other IOP-lowering surgery should be made on a patient-by-patient basis, taking into consideration glaucoma severity, baseline and target IOP as well as current medication burden,” researchers wrote.
The large variance in IOP reductions after phaco ranged from 1.2% to 29.4% and may be the result of surgical variations or by differences in patient characteristics between as well as within the studies, they said.
“... if phacoemulsification can, at least temporarily, reduce the medication burden on patients, this may open a window during which there is, potentially, a reduced risk of glaucoma surgical failure,” they said. — by Abigail Sutton
Disclosures: The researchers report no relevant financial disclosures.
Perspective
Back to Top
Lisa M. Young, OD, FAAO
It used to be that combined cataract and glaucoma surgical procedures were reserved for patients with moderate to severe glaucoma, typically consisting of a tube or trabeculectomy in addition to phaco. With the advent of minimally invasive glaucoma surgeries (MIGS), our arsenal of treatment options for glaucoma continues to expand, and more and more surgeons are combining these procedures with phaco.
Of course, every treatment option has potential risks and benefits, which all have to be weighed given the severity and rate of progression of the disease.
Armstrong and colleagues found that phacoemulsification alone significantly reduces IOP and also lessens dependency on topical glaucoma medications. While these findings may not particularly benefit patients who have moderate or severe glaucoma with target IOPs in the low-to mid-teens, it may be of value to those who have mild to moderate glaucoma. In particular, patients who are of low risk, have mild glaucoma or do not need aggressive treatment may have sufficient results with phaco as a solo procedure rather than combined with a MIGS.
The bottom line is that less is sometimes more.
Click Here to Manage Email Alerts