J Korean Ophthalmol Soc.  2018 Oct;59(10):930-937. 10.3341/jkos.2018.59.10.930.

The Effect of Intraoperative Factors on Intraocular Pressure Reduction after Phacoemulsification in Open-angle Glaucoma

• Park Y
• Moon JI
• Cho KJ

• KMID: 2422581
• DOI: http://doi.org/10.3341/jkos.2018.59.10.930

Abstract

PURPOSE
To identify independent predictors of long-term postoperative intraocular pressure (IOP) reduction after phacoemulsification in patients with primary open-angle glaucoma (POAG).
METHODS
This was a retrospective review of 145 eyes with open-angle glaucoma (OAG) who were followed up for more than 3 years after uncomplicated phacoemulsification cataract surgeries. Demographic, clinical, biometric, and intraoperative variables such as IOP, refractive errors, anterior chamber depth, axial length, relative lens position (RLP), and phacoemulsification parameters such as phaco time, cumulative dissipated energy (CDE), and balanced salt solution volume were evaluated at 6, 12, 24, and 36 months after surgery. Univariate and multivariate linear regression were used to analyze the relationship between these variables and the postoperative IOP.
RESULTS
There was a statistically significant average postoperative IOP reduction at 6, 12, 24, and 36 months of −1.9 ± 2.9, −1.6 ± 2.8, −1.4 ± 3.1, and −1.2 ± 2.7 mmHg, respectively (p < 0.01). Higher preoperative IOP (p < 0.001), a more relative anterior lens position (p < 0.001), shorter phaco time (p < 0.05), and higher CDE (p < 0.05) were significantly associated with a greater postoperative decrease in IOP using univariate analyses. Using multivariate analyses, preoperative IOP (p < 0.01), lens position (p = 0.04), and phaco time (p = 0.04) were associated with greater postoperative IOP reduction at 3 years.
CONCLUSIONS
Higher preoperative IOP was associated with a greater IOP-lowering effect after phacoemulsification in OAG patients. Phaco time and anterior RLP were independently associated with IOP reduction after adjusting for age and preoperative IOP. These findings have important implications when considering combined cataract extraction and filtration surgery for POAG patients.

Keyword

Cataract; Intraocular pressure; Open-angle glaucoma; Phacoemulsification

MeSH Terms

Anterior Chamber
Cataract
Cataract Extraction
Filtering Surgery
Glaucoma, Open-Angle*
Humans
Intraocular Pressure*
Linear Models
Multivariate Analysis
Phacoemulsification*
Refractive Errors
Retrospective Studies

Figure

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  Figure 1 Change in mean intraocular pressure (IOP) over 36 months after phacoemulsification. The mean postoperative IOP was significantly lower than preoperative IOP during the follow-up period.

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  Figure 2 Association of amount of change in intraocular pressure (IOP) after phacoemulsification and preoperative IOP. High preoperative IOP was significantly associated with postoperative IOP reduction.

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