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

Yuli Park; Jung Il Moon; Kyong Jin Cho

doi:10.3341/jkos.2018.59.10.930

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Park, Moon, and Cho: The Effect of Intraoperative Factors on Intraocular Pressure Reduction after Phacoemulsification in Open-angle Glaucoma

Original Article

Journal of the Korean Ophthalmological Society 2018; 59(10): 930-937.

Published online: 17 October 2018

DOI: https://doi.org/10.3341/jkos.2018.59.10.930

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

Yuli Park, MD¹, Jung Il Moon, MD, PhD², Kyong Jin Cho, MD, PhD¹

¹Department of Ophthalmology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea.

²Department of Ophthalmology, Yeouido St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Address reprint requests to Kyong Jin Cho, MD, PhD. Department of Ophthalmology, Dankook University Hospital, #201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea. Tel: 82-41-550-6497, Fax: 82-41-556-0524, perfectcure@hanmail.net

Received 26 April 2018 Revised 4 July 2018 Accepted 28 September 2018

The Korean Ophthalmological Society

(open-access):

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 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.

Keywords: Cataract, Intraocular pressure, Open-angle glaucoma, Phacoemulsification

Figures and Tables

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.

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.

Table 1

Baseline demographic, clinical, biometric, and intraoperative characteristics of the subjects

Values are presented as mean ± SD or n (%) unless otherwise indicated.

D = diopter; BSS = balanced salt solution; IOP = intraocular pressure.

Table 2

Univariate predictors of the change in mean postoperative IOP through 36 months with clinical, biometric, and intraoperative parameters

IOP = intraocular pressure; D = diopter; BSS = balanced salt solution.

Table 3

Multivariate analysis of clinical predictors of postoperative IOP reduction

IOP = intraocular pressure.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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