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Study investigates IOP changes related to femtosecond laser-assisted cataract surgery
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In eyes with glaucoma, as well as in healthy eyes, femtosecond laser-assisted cataract surgery leads to an initial IOP rise, followed by significant decrease at 1 month. Reduction is sustained in eyes with glaucoma over 3 years, according to a study.
The effects of cataract surgery on IOP are well known, and cataract surgery is often used as a way of managing glaucoma. However, it is not known whether femtosecond-assisted surgery has effects comparable to standard phacoemulsification.
A group of researchers at the University of Colorado performed a retrospective study on 504 eyes that underwent the femtosecond laser-assisted procedure between February 2012 and April 2015; 278 had a preoperative diagnosis of glaucoma or glaucoma suspect and 226 were healthy controls.
Both the glaucoma/glaucoma suspect group and the control group had an initial mean increase in IOP at day 1. Spikes of 10 mm Hg or 20 mm Hg were uncommon but were more than twice as frequent in the glaucoma/glaucoma suspect group, where mean IOP elevation was higher overall. At 1 week, IOP was back to baseline values, and at 1 month both groups had a significant decrease in IOP as compared with baseline. This decrease was maintained for 1 year in the healthy eyes and over the entire follow-up of 3 years in eyes with glaucoma/glaucoma suspect.
The soft or rigid patient interface of the femtosecond lasers used in the study did not have a different effect on IOP elevation. In several eyes operated before June 2014, a rigid applanator was used, while all subsequent cases were performed with the soft applanator.
“Despite the intraoperative differences in IOP noted in previous studies, we found no significant difference in long-term IOP at any postoperative timepoint,” the authors wrote.
Further, prospective studies evaluating glaucoma progression after femtosecond laser-assisted cataract surgery are warranted, the authors. – by Michela Cimberle
Disclosure: Shah reported no relevant financial disclosures. Please see the published paper for the other authors’ financial disclosures.
Perspective
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Lisa M. Young, OD, FAAO
When it comes to cataract surgery, there are several different “premium” options to consider such as toric IOL, multifocal IOL, multifocal toric IOL, all with or without laser-assisted surgery.
While there isn’t a specific algorithm for determining the best option, we do know that special considerations must be taken for our glaucoma patients contemplating cataract surgery, as surgical complications may have a greater impact. We must consider not only the visual impact of glaucoma on our IOL selection, but also the potential IOP implications of surgery.
Many doctors hesitate to recommend laser-assisted cataract surgery for glaucoma patients due to IOP-related concerns. We know that IOP is transiently elevated during the docking of the laser device.
Also, this recent retrospective study by Shah and colleagues noted that an IOP spike was more common in glaucoma patients on the first postsurgical day when performing femtosecond laser-assisted cataract surgery but that there wasn’t a significant difference in IOP from baseline after the first week.
It remains to be seen if the benefit of laser-assisted surgery justifies the cost. It may be a reasonable consideration for patients with mild glaucoma, but my concern is greater for patients with more advanced glaucoma.
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