Influence of Phacoemulsification on Progression of Glaucoma and Analysis of Related Factors in Glaucoma Patients

Ga Young Yoo; Hyung Bin Hwang; Myoung Hee Park; Hyun Seung Kim

doi:10.3341/jkos.2013.54.8.1193

Journal List > J Korean Ophthalmol Soc > v.54(8) > 1009445

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Yoo, Hwang, Park, and Kim: Influence of Phacoemulsification on Progression of Glaucoma and Analysis of Related Factors in Glaucoma Patients

Original Article

J Korean Ophthalmol Soc 2013;54(8):1193-1198.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.8.1193

Influence of Phacoemulsification on Progression of Glaucoma and Analysis of Related Factors in Glaucoma Patients

Ga Young Yoo, MD, Hyung Bin Hwang, MD, Myoung Hee Park, MD, PhD, Hyun Seung Kim, MD, PhD

Department of Ophthalmology and Visual Science, Yeouido St. Mary’s Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea

Address reprint requests to Hyun Seung Kim, MD, PhD Department of Ophthalmology, The Catholic University of Korea, Yeouido St. Mary’s Hospital #10 63-ro, Yeongdeungpo-gu, Seoul 150-713, Korea Tel: 82-2-3779-1243, Fax: 82-2-761-6869 E-mail: sara514@catholic.ac.kr

Received 15 December 20124 March 2013 Accepted 15 May 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the factors affecting glaucoma progression after cataract surgery with phacoemulsification.

Methods

The medical charts of 109 eyes of 68 patients with glaucoma who had phacoemulsification were retrospectively reviewed. The course of glaucoma was followed up for at least 2 years. Age, sex, diabetes, hypertension, preoperative mean deviation, phacoemulsification time, cataract type, refractive error, preoperative and postoperative visual acuity, preoperative and postoperative intraocular pressure, axial length, and central corneal thickness between the progression group and the non-progression group were compared.

Results

Among 109 eyes with glaucoma, 19 (17.4%) eyes were classified into the glaucoma progression group. In the multivariate analysis, age (p = 0.026), preoperative mean deviation (p < 0.001), and phacoemulsification time (p < 0.001) were statistically associated with glaucoma progression.

Conclusions

For patients with glaucoma, phacoemulsification may result in its progression. Special attention should be given to patients with the above risk factors.

Keywords: Cataract, Glaucoma, Phacoemulsification

References

1. Lichter PR, Musch DC, Gillespie BW. . Interim clinical out-comes in the Collaborative Initial Glaucoma Treatment Study com-paring initial treatment randomized to medications or surgery. Ophthalmology. 2001; 108:1943–53.

2. Kim YY, Kim JS, Shin DH. . Effect of cataract extraction on blue-on-yellow visual field. Am J Ophthalmol. 2001; 132:217–20.

3. Chen PP, Budenz DL. The effects of cataract extraction on the visu-al field of eyes with chronic open-angle glaucoma. Am J Ophthalmol. 1998; 125:325–33.

4. Hayashi K, Hayashi H, Nakao F, Hayashi F. Influence of cataract surgery on automated perimetry in patients with glaucoma. Am J Ophthalmol. 2001; 132:41–6.

5. Lam BL, Alward WL, Kolder HE. Effect of cataract on automated perimetry. Ophthalmology. 1991; 98:1066–70.

6. Lee KS, Park JW. Effect of cataract extraction on visual field test in patients with glaucoma. J Korean Ophthalmology Soc. 2010; 51:55–62.

7. Anderson DR. Automated static perimetry. 1st ed.St. Louis: Mosby;1992; 25–30.

8. Jahn CE. Reduced intraocular pressure after phacoemulsification and posterior chamber intraocular lens implantation. J Cataract Refract Surg. 1997; 23:1260–4.

9. Liu CJ, Cheng CY, Wu CW. . Factors predicting intraocular pressure control after phacoemulsification in angle-closure glaucoma. Arch Ophthalmol. 2006; 124:1390–4.

10. Park S, Lee M, Ahn J. Relationship between preoperative biometry and intraocular pressure reduction after phacoemulsification in normal and glaucoma patients. J Korean Ophthalmol Soc. 2012; 53:111–9.

11. Rand Allingham R, Moroi SE. Surgical approaches for coexisting glaucoma and cataract. In: Rand Allingham R, Damji KF, Sharon Freedman, Moroi SE, Bruce Shields, eds. Shield's Textbook of Glaucoma. 6th ed.Philadelphia: Lippincott Wiliams & Wilkins;2010; chap. 41.

12. Leske MC, Heijl A, Hyman L. . Factors for progression and glaucoma treatment: the Early Manifest Glaucoma Trial. Curr Opin Ophthalmol. 2004; 15:102–6.

13. Koucheki B, Nouri-Mahdavi K, Patel G. . Visual field changes after cataract extraction: the AGIS experience. Am J Ophthalmol. 2004; 138:1022–8.

14. Oshika T, Yoshimura K, Miyata N. Postsurgical inflammation after phacoemulsification and extracapsular extraction with soft or con-ventional intraocular lens implantation. J Cataract Refract Surg. 1992; 18:356–61.

15. Pande MV, Spalton DJ, Kerr-Muir MG, Marshall J. Postoperative inflammatory response to phacoemulsification and extracapsular cataract surgery: aqueous flare and cells. J Cataract Refract Surg. 1996; 22 Suppl. 1:770–4.

16. Ohrloff C, Zubcov AA. Comparison of phacoemulsification and planned extracapsular extraction. Ophthalmologica. 1997; 211:8–12.

17. Kreutzer TC, Al Saeidi R, Kampik A, Grueterich M. Real-time in-traocular pressure measurement in standard and microcoaxial phacoemulsification. J Cataract Refract Surg. 2010; 36:53–7.

18. McCulley TJ, Lam BL, Feuer WJ. Incidence of nonarteritic ante-rior ischemic optic neuropathy associated with cataract extraction. Ophthalmology. 2001; 108:1275–8.

19. McCulley TJ, Lam BL, Feuer WJ. Nonarteritic anterior ischemic optic neuropathy and surgery of the anterior segment: temporal re-lationship analysis. Am J Ophthalmol. 2003; 136:1171–2.

20. Lee H, Kim CY, Seong GJ, Ma KT. A case of decreased visual field after uneventful cataract surgery: nonarteritic anterior ischemic op-tic neuropathy. Korean J Ophthalmol. 2010; 24:57–61.

Table 1.

Characteristics of patients

No. of eyes	109
Age (year, range)	70.9 ± 5.4 (61-82)
Sex (M : F)	35 : 74
Mean deviation (dB)	11.9 ± 5.5
SE (diopter)	-0.9 ± 0.7
Preoperative IOP (mm Hg)	15.05 ± 2.72
CCT (um)	540.3 ± 30.5
AL (mm)	23.4 ± 1.2
Preoperative VA	0.64 ± 0.57
Follow-up (months)	28.7 ± 2.4

Values are presented as mean ± SD.

SE = spherical equivalent; IOP = intraocular pressure; CCT = central corneal thickness; AL = axial length; VA = visual acuity.

Table 2.

Progression of glaucoma, 2 years after phacoemulsi-fication

	Number (%)
Non-progression G	90 (82.6%)
Progression G	19 (17.4%)
Total	109

Table 3.

Changes in best-corrected visual acuity, intraocular pressure, number of medication, and mean deviation be phacoemulsification efore and after

Variable		PreOp	PostOp	Difference	p-value
BCVA (log MAR)	Non-progression G	0.63 ± 0.61	0.21 ± 0.25	-0.42 ± 0.49	<0.001^*
	Progression G	0.71 ± 0.40	0.24 ± 0.23	-0.46 ± 0.27	<0.001^†
IOP	Non-progression G	15.0 ± 1.76	13.71 ± 2.24	-1.29 ± 2.26	0.024^*
	Progression G	15.28 ± 2.40	14.17 ± 2.07	-1.11 ± 2.95	0.196^†
Number of medication	Non-progression G	1.57 ± 0.75	1.22 ± 0.75	-0.36 ± 0.58	<0.001^*
	Progression G	1.50 ± 0.99	2.18 ± 0.88	0.64 ± 0.86	0.013^†
MD	Non-progression G	-10.94 ± 2.11	-8.71 ± 2.30	2.23 ± 2.41	<0.001^*
	Progression G	-16.51 ± 7.99	-18.96 ± 5.41	2.44 ± 4.62	0.04^†

PreOP = preoperative; PostOP = postoperative; BCVA = best corrected visual acuity; IOP = intraocular pressure; MD = mean daviation.

^* Wilcoxon signed ranks test;

^† Paired t-test.

Table 4.

Univariate analysis of risk factors for glaucoma progression after phacoemulsification

Variable		Number of patients (%)		p-value
Variable		Non-progression G	Progression G	p-value
Age (years)	≤74	60 (66.7)	8 (42.1)	0.045
	≥75	30 (33.3)	11 (57.9)
Sex	Male	28 (31.1)	7 (36.8)	0.627
	Female	62 (68.9)	12 (63.2)
Mean deviation (dB)	<-12	63 (70.0)	7 (36.8)	0.006
	≥-12	27 (30.0)	12 (63.2)
Phaco time (sec)	<60	51 (56.7)	4 (21.1)	0.005
	≥60	39 (43.3)	15 (78.9)
Nuclear cataract	Cortical	48 (53.3)	6 (31.6)	0.085
	Nuclear	42 (46.7)	13 (68.4)
SE (D)	>-1	17 (18.9)	4 (21.1)	0.828
	≤-1	73 (81.1)	15 (78.9)
Preoperative IOP (mm Hg)	≤14	40 (44.9)	12 (63.2)	0.149
	≥15	49 (55.1)	7 (36.8)
Postoperative IOP (mm Hg)	≤14	68 (75.6)	15 (78.9)	0.753
	≥15	22 (24.4)	4 (21.1)
CCT (um)	<550	34 (37.8)	9 (47.4)	0.437
	≥550	56 (62.2)	10 (52.6)
Axial length (mm)	<26	66 (73.3)	14 (73.7)	0.975
	≥26	24 (26.7)	5 (26.3)
Preoperative V/A	>0.7	46 (51.1)	10 (52.6)	0.904
	≤0.7	44 (48.9)	9 (47.4)
Postoperative V/A	>0.7	6 (6.7)	3 (15.8)	0.189
	≤0.7	84 (93.3)	16 (84.2)
DM	No	55 (61.1)	12 (63.2)	0.868
	Yes	35 (38.9)	7 (36.8)
HBP	No	65 (72.2)	13 (68.4)	0.739
	Yes	25 (27.8)	6 (31.6)

Phaco time = phacoemulsification time; SE = spherical equivalent; IOP = intraocular pressure; CCT = central corneal thickness; DM = diabetes mellitus; HBP = hypertension; V/A = visual acuity. .

Table 5.

Multivariate analysis of risk factors of glaucoma progression after phacoemulsification

Variable	Odds ratio	95% CI	p-value
Age	1.013	1.002-1.025	0.026
Mean deviation	1.119	1.090-1.149	<0.001
Phaco time	1.102	1.071-1.134	<0.001
Nuclear cataract	1.245	0.944-1.642	0.121

Phaco time = phacoemulsification time; CI = confidence interval.

TOOLS

Similar articles