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Phaco with IOL potential treatment for adjunct IOP control
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Routine phacoemulsification with IOP implantation led to a modest IOP reduction in patients with medically controlled, mild to moderate open-angle glaucoma and visually significant cataracts, according to researchers.
The prospective study enrolled 81 eyes of 69 patients with open angle glaucoma (OAG); 21 were men, and 48 were women.
The narrow angle group included 28 eyes of 24 women and four men. The open angle group included 53 eyes of 36 women and 17 men.
Of the 69 patients, 74 were using a prostaglandin analog (PGA), 32 patients were using a beta-adrenoceptor antagonist, 19 were taking an alpha-adrenoceptor agonist, and 32 were taking a carbonic anhydrase inhibitor.
Patients resumed glaucoma medications the day after surgery except for PGAs, which were resumed after 1 month.
Researchers found significant differences in the preoperative anterior segment optical coherence tomography parameters between the narrow angle group and the open angle group.
The narrow angle group had a smaller angle-opening distance at 500 µm, angle-opening distance at 750 µm and trabecular-iris surface area at 750 µm than the open angle group. The angle-opening distance at 500 µm and angle-opening distance at 750 µm were 0.14 mm and 0.16 mm larger, respectively, in the open angle group, according to researchers.
Narrow angle eyes also had a smaller anterior chamber depth and anterior chamber volume at baseline than open angle eyes.
They also reported a greater absolute IOP reduction and percentage change in the narrow angle group than the open angle group.
The significant predictors of IOP reduction were preoperative IOP, angle-opening distance at 500 µm, angle-opening distance at 750 µm, trabecular-iris surface area at 750 µm, and lens vault.
After adjusting for preoperative IOP, age and sex, the multivariate analysis showed preoperative IOP, angle opening distance at 500 µm, angle opening distance at 750 µm and lens vault were the significant predictors for IOP reduction.
Phacoemulsification with IOP implantation led to a mean IOP reduction of 2.17 mm Hg, or a 12.3% decrease, from a mean preoperative IOP of 15.02 mmHg, for eyes with medically controlled mild to moderate OAG.
This is the first study showing that preoperative angle-opening distance and lens vault can be predictors for IOP reduction in this patient population, according to researchers. – by Abigail Sutton
Disclosu re : The researchers report no relevant financial disclosures.
Perspective
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Derek MacDonald, OD, FAAO
I had the privilege of spending Friday at SUNY College of Optometry learning more about Don Hood’s approach to utilizing optical coherence tomography in the management of glaucoma … what a day. On the flight home, it struck me just how much our understanding of this disease continues to evolve, while our treatment remains rooted in lowering IOP.
On the bright side, at least we are finding more means to that end. While prostaglandin analogs are now over 20 years old, novel drugs targeting trabecular outflow, episcleral venous pressure and the nitric oxide pathway are just around the corner. Combination products simplify dosing and improve patient adherence (we hope), while nonpreserved and BAK-free preparations increase treatment tolerance.
Selective laser trabeculoplasty has assumed a prominent and earlier role in the treatment paradigm, and minimally invasive glaucoma surgeries appear poised to follow suit. Cataract surgery has almost gotten lost in the shuffle, but Hsia and colleagues remind us of its value in safely and effectively lowering pressure, particularly in eyes with higher IOP and narrow angles. Unlike other treatments, cataract extraction also improves vision, facilitates monitoring of both structure and function and merits strong consideration in the management of patients with both OAG and ACG.
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