Effect of Preoperative Factors and Gonioscopy on Intraocular Pressure Reduction after Phacoemulsification in Glaucoma

Yuli Park; Young Bin Kim; Kyong Jin Cho

doi:10.3341/jkos.2019.60.5.463

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Park, Kim, and Cho: Effect of Preoperative Factors and Gonioscopy on Intraocular Pressure Reduction after Phacoemulsification in Glaucoma

Original Article

J Korean Ophthalmol Soc 2019;60(5):463-469.

Published online: 25 September 2019

DOI: https://doi.org/10.3341/jkos.2019.60.5.463

Effect of Preoperative Factors and Gonioscopy on Intraocular Pressure Reduction after Phacoemulsification in Glaucoma

Yuli Park, MD, Young Bin Kim, MD, Kyong Jin Cho, MD, PhD

Department of Ophthalmology, Dankook University College of Medicine, Cheonan, 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 E-mail: perfectcure@hanmail.net

Received 25 October 2018 Revised 23 December 2018 Accepted 25 April 2019

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 a new gonioscopy score and preoperative factors as a potential predictor for intraocular pressure (IOP) reduction after phacoemulsification.

Methods

This is a retrospective review of 182 eyes with glaucoma of either open or narrow angles that underwent phacoemulsification. Preoperative variables such as age, IOP, refractive errors, anterior chamber depth (ACD), axial length, and lens position were evaluated at 6 months after surgery. A preoperative gonioscopy score was created, summing the Shaffer gonioscopy grading in 4 quadrants. To determine variables associated with IOP change at 6 months, univariate and multivariate linear regression analysis was performed.

Results

The mean age of the patients was 72.8 ± 9.5 years and the average preoperative IOP was 16.4 ± 3.7 mmHg with 1.2 glaucoma medications. The mean IOP reduction after phacoemulsification was 2.7 ± 2.2 mmHg at postoperative 6 months. Preoperative IOP (β = 0.55, p < 0.001), gonioscopy score (β = −0.29, p < 0.001), ACD (β = −0.67, p = 0.02), and IOP/ACD ratio (β = 0.58, p = 0.01) were associated with IOP reduction at 6 months.

Conclusions

Preoperative predictors for IOP reduction after phacoemulsification were preoperative IOP, ACD, gonioscopy score, and IOP/ACD ratio in patients with glaucoma. The IOP/ACD ratio and gonioscopy score can be easy parameters to obtain and may help clinicians to estimate the IOP reduction after phacoemulsification.

Keywords: Glaucoma, Gonioscopy, Intraocular pressure, Phacoemulsification

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Figure 1.

The relationship between significant preoperative predictors with IOP reduction following phacoemulsification after multivariate analysis. (A) Relationship between preoperative IOP and IOP reduction. (B) Relationship between gonioscopy score and IOP reduction. (C) Relationship between preoperative ACD and IOP reduction. (D) Relationship between IOP/ACD ratio and IOP reduction are presented. IOP = intraocular pressure; ACD = anterior chamber depth.

Table 1.

Baseline demographic and biometric characteristics of the patients

Parameter	Value
Age (years)	72.8 ± 9.5
Sex (male/female)	77/70
Glaucoma medication (n)	1.2 ± 0.3
Nuclear sclerosis grade >3+	108 (59.3)
Anterior chamber depth (mm)	2.8 ± 0.5
Central corneal thickness (μ m)	547.3 ± 39.8
Gonioscopy score (n)	9.8 ± 4.5
Axial length (mm)	24.1 ± 1.5
Spherical equivalent (D)	−0.46 ± 2.38
Average keratometry (D)	44.27 ± 3.09
Mean preoperative IOP (mmHg)	16.4 ± 3.7

Values are presented as mean ± standard deviation or number (%) unless otherwise indicated.

D = diopter; IOP = intraocular pressure.

Table 2.

Univariate and multivariate analysis of the association between clinical preoperative predictors and changes in IOP at 6 months after phacoemulsification

Parameter	Univariate analysis		Multivariate analysis^*
Parameter	β	p-value	β	p-value
Age (years)	0.03	0.39	–	–
Sex (female/male)	0.02	0.64	–	–
Preoperative IOP (mmHg)	0.63	<0.001	0.55	<0.001
Gonioscopy score (n)	−0.31	<0.001	−0.29	<0.001
ACD (mm)	−0.75	0.01	−0.67	0.02
Axial length (mm)	−0.28	0.02	−0.21	0.07
CCT (μ m)	0.01	0.53	–	–
Preoperative spherical equivalent (D)	0.09	0.48	–	–
Lens thickness (mm)	0.12	0.12	–	–
IOP/ACD ratio	0.89	<0.001	0.58	0.01

IOP = intraocular pressure; ACD = anterior chamber depth; CCT = central corneal thickness; D = diopter.

^* In multivariate analysis, preoperative IOP was adjusted for age and sex. gonioscopy score, axial length, ACD, and IOP/ACD ratio were adjusted for age, sex, and preoperative intraocular pressure.

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