Long Term Intraocular Pressure Change after Phacoemulsification with Intraocular Lens Implantation in Glaucomatous and Non-glaucomatous Patients, Panyananthaphikkhu Chonprathan Medical Center
Article Sidebar
Main Article Content
Abstract
MATERIAL AND METHODS: A retrospective analysis of 208 patients who had undergone phacoemulsification by the same surgeon at Panyananthaphikkhu Chonprathan Medical Center between February 2011 and February 2015. The patients were divided into 3 groups: no glaucoma (NG), primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Preoperative and postoperative best-corrected visual acuity (VA), IOP, and the number of glaucoma medications were recorded. IOP was evaluated before surgery and post-surgery for 1 month, 3 months, and last follow-up (mean 40 months). Repeated measure ANOVA and Post hoc by Scheffe test was used to compare IOP between 3 groups over time. Paired t-test was conducted to determine the relationship between preoperative IOP and postoperative IOP. The p-value of less than 0.05 was set for statistically significant.
RESULT: There were 86 patients in the NG group, 61 patients in the POAG group, and 61 patients in the PACG group. The first month saw the mean IOP significantly decrease in all groups (p < 0.001): NG group decreased 2.06 ± 2.21mmHg, POAG group 2.97 ± 3.25 mmHg, and PACG group 3.18 ± 2.77 mmHg. At 3 months the mean IOP was significantly decrease in all group(p < 0.001):NG group decreased 2.44 ± 2.14 mmHg, POAG group 2.72 ± 2.73 mmHg, and PACG group 3.51 ± 2.78 mmHg. At the final follow-up visit the mean IOP still significantly decrease in all group (p < 0.001): NG group decreased 1.45 ± 1.96 mmHg, POAG group 2.17 ± 2.98 mmHg, and PACG group 3.32 ± 2.84 mmHg. Eye with higher preoperative IOP has the greatest IOP- lowering effect. The number of glaucoma medication slightly decreased even though they are both the groups of open and closed angle (p = 0.002 VS p < 0.001). Visual acuity was significantly improved after phacoemulsification in all group.
CONCLUSION: Phacoemulsification not only improves the visual acuity but also provides a long term significant decrease in IOP and glaucoma medication. This IOP-lowering effect is proportional to preoperative IOP.
Article Details
This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
Singalavanija A, Metheetrairut A, Ruangvaravate N, et al. Ocular diseases and blindness in elderly Thais. J Med Assoc Thai 2001;84:1383-8.
Bourne RR, Sukudom P, Foster PJ, et al. Prevalence of glaucoma in Thailand: a population-based survey in RomKlao District, Bangkok. Br J Ophthalmol 2003;87:1069-7.
Pascolini D, Mariotti SP: Global estimates of visual impairment: 2010. Br J Ophthalmol 2012; 96:614-8.
Thylefors B, Negrel AD, Pararajasegaram R, et al. Global data on blindness. Bull WHO 1995;73:115-21.
Tham YC1, Li X2, Wong TY1, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 2014;121:2081-90.
Suzuki R, Kuroki S, Fujiwara N. Ten-year follow-up of intraocular pressure after phacoemulsification and aspiration with intraocular lens implantation performed by the same surgeon. Ophthalmologica 1997;211:79-83.
Shingleton BJ, Gamell LS, O’Donoghue MW, et al. Long-term changes in intraocular pressure after clear corneal phacoemulsification: normal patients versus glaucoma suspect and glaucoma patients. J Cataract Refract Surg 1999;25: 885-90.
Poley BJ, Lindstrom RL, Samuelson TW. Long-term effects of phacoemulsification with intraocular lens implantation in normotensive and ocular hypertensive eyes. J Cataract Refract Surg 2008;34:735-42.
Siak J, Quek D, Nongpiur ME, et al. Anterior chamber angle and intraocular pressure changes after phacoemulsification: a comparison between eyes with closed-angle and open-angle glaucoma. J Glaucoma 2016;25:259-64.
Hayashi K, Hayashi H, Nakao F, et al. Effect of cataract surgery on intraocular pressure control in glaucoma patients. J Cataract Refract Surg 2001;27:1779-86.
Walland MJ, Parikh RS, Thomas R, et al. There is insufficient evidence to recommend lens extraction as a treatment for primary open-angle glaucoma: an evidence-based perspective. Clin Exp Ophthalmol 2012;40:400-7.
Vizzeri G, Weinreb RN. Cataract surgery and glaucoma. Curr Opin Ophthalmol 2010;21:20-4.
Ahmed II, Kranemann C, Chipman M, et al. Revisiting early postoperative follow-up after phacoemulsification. J Cataract Refract Surg 2002;28:100-8.
Leelachaikul Y, Euswas A. Long-term intraocular pressure change after clear corneal phacoemulsification in Thai glaucoma patients. J Med Assoc Thai 2005;88(Suppl 9):S21-5.
Euswas A, Warrasak S. Intraocular pressure control following phacoemulsification in patients with chronic angle closure glaucoma. J Med Assoc Thai 2005;88(Suppl): S121-5.
Pachimkul P, Intajak Y. Effect of lens extraction on primary angle closure in a Thai population. J Med Assoc Thai 2008;91:303-8.
Yudhasompop N, Wangsupadilok B. Effects of phacoemulsification and intraocular lens implantation on intraocular pressure in primary angle closure glaucoma (PACG) patients. J Med Assoc Thai 2012;95:557–60.
Shingleton J, Bradford; Pasternack J, et al. Three and Five Year Changes in Intraocular Pressures after Clear Corneal Phacoemulsification in Open Angle Glaucoma Patients, Glaucoma Suspects, and Normal Patients. J Glaucoma 2006;15:494-8.
Poley BJ, Lindstrom RL, Samuelson TW, et al. Intraocular pressure reduction after phacoemulsification with intraocular lens implantation in glaucomatous and nonglaucomatous eyes: Evaluation of a causal relationship between the natural lens and open-angle glaucoma. J Cataract Refract Surg 2009;35:1946-55.
Kim M, Park KH, Kim TW, et al. Anterior chamber configuration changes after cataract surgery in eyes with glaucoma. Korean J Ophthalmol 2012;26:97-103.
Zhao Z, Zhu X, He W, et al. Schlemm’s canal expansion after uncomplicated phacoemulsification surgery: an optical coherence tomography study. Invest Ophthalmol Vis Sci 2016; 57:6507-12.
Alaghband P, Beltran-Agulló L, Galvis EA, et al. Effect of phacoemulsification on facility of outflow. Br J Ophthalmol 2018;102:1520.
Gedde SJ, Schiffman JC, Feuer WJ, et al. Treatment outcomes in the tube versus trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol 2012;153:789-803.
Gedde SJ, Herndon LW, Brandt JD, et al. Postoperative complications in the tube versus trabeculectomy (TVT) study during five years of follow-up. Am J Ophthalmol 2012;153:804-14.