Predictors of intraocular pressure change after cataract surgery in patients with pseudoexfoliation glaucoma and in nonglaucomatous patients

Bojana Markić; Milka Mavija; Saša Smoljanović-Skočić; Miljana Tepić Popović; Sanela Sanja Burgić

doi:10.2298/VSP200421081M

Bojana Markić ; University Clinical Center of the Republic of Srpska, Clinic for Eye Diseases, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
Milka Mavija ; University Clinical Center of the Republic of Srpska, Clinic for Eye Diseases, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
Saša Smoljanović-Skočić ; University Clinical Center of the Republic of Srpska, Clinic for Eye Diseases, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
Miljana Tepić Popović ; University Clinical Center of the Republic of Srpska, Clinic for Eye Diseases, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
Sanela Sanja Burgić ; University Clinical Center of the Republic of Srpska, Clinic for Eye Diseases, Banja Luka, Republic of Srpska, Bosnia and Herzegovina

DOI: https://doi.org/10.2298/VSP200421081M

Keywords: cataract surgery;, glaucoma;, intraocular pressure;, ophtalmologic surgical procedures;, postoperative complications

Abstract

Background/Aim. The cataract surgery in eyes with and without glaucoma results in the sustained intraocular pressure (IOP) reduction but it is still unknown which glaucomatous patients will achieve clinically significant reduction. The preoperative IOP and some ocular biometric parameters have been shown as potential predictors of the postoperative IOP reduction. The aim of our prospective intervention study was to evaluate that relationship in medically controlled patients with the pseudoexfoliation glaucoma (PXG) and in the nonglaucomatous patients. Methods. Thirty-one PXG patients (31 eyes) and 31 nonglaucomatous patients (31 eyes), all with clinically significant cataract, were enrolled. The preoperative IOP, anterior chamber depth (ACD), axial length (AL), lens thickness (LT), lens position (LP) [LP = ACD + 0.5 LT], relative lens position (RLP) [RLP = LP / AL] and the pressure-to-depth ratio (PD ratio) [PD ratio = preoperative IOP/preoperative ACD] were evaluated as potential predictors of the IOP change in the 6th postoperative month. Results. In the 6th postoperative month, in the PXG group, the IOP reduction was -3.23 ± 3.41 mmHg (-17.67 ± 16.86%) from the preoperative value of 16.27 ± 3.08 mmHg and in the control group, the reduction was -2.26 ± 1.71 mmHg (-15.06 ± 10.93%) from the preoperative value of 14.53 ± 2.04 mmHg. In the PXG group, the significant predictors of the absolute and the percentage IOP reduction were the preoperative IOP, AL, and PD ratio. In the same group, RLP was shown as a significant predictor of absolute change in the IOP in multivariate analysis, and the percentage IOP change in both the univariate and the multivariate analyses. In the control group, the preoperative IOP and the PD ratio were the only significant parameters that could predict absolute change in the postoperative IOP. Conclusion. The cataract surgery leads to the IOP reduction both in the PXG and nonglaucomatous eye. Predictors monitored in this study are widely available and simply calculable parameters that can be potentially used in managing glaucoma.

Author Biographies

Bojana Markić, ; University Clinical Center of the Republic of Srpska, Clinic for Eye Diseases, Banja Luka, Republic of Srpska, Bosnia and Herzegovina

specijalista oftalmolog

viši asistent na Katedri za oftalmologiju

Medicinski fakultet Banja Luka

Milka Mavija, ; University Clinical Center of the Republic of Srpska, Clinic for Eye Diseases, Banja Luka, Republic of Srpska, Bosnia and Herzegovina

Načelnik Klinike za očne bolesti UKC RS

Šef katedre za Oftalmologiju, Medicinski fakultet Banja Luka, Univerzitet u Banja Luci

References

Stamper RL, Lieberman MF, Drake MV. Medical treatment of glaucoma: general principles. In: Stamper RL, Lieberman MF, Drake MV, editors. Becker-Shaffer's Diagnosis and Therapy of the Glaucomas. 8th ed. Philadelphia: Mosby; 2009. p. 346.

Chen PP, Lin SC, Junk AK, Radhakrishnan S, Singh K, Chen TC, et al. The Effect of Phacoemulsification on Intraocular Pres-sure in Glaucoma Patients: A Report by the American Acad-emy of Ophthalmology. Ophthalmology 2015; 122(7): 1294‒307.

Poley BJ, Lindstrom RL, Samuelson TW, Schulze R Jr. 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(11): 1946–55.

Slabaugh MA, Bojikian KD, Moore DB, Chen PP. The effect of phacoemulsification on intraocular pressure in medically con-trolled open-angle glaucoma patients. Am J Ophthalmol 2014; 157(1): 26‒31.

Shingleton BJ, Pasternack JJ, Hung JW, O'Donoghue MW. Three and five year changes in intraocular pressures after clear cor-neal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and normal patients. J Glaucoma 2006; 15(6): 494–8.

Liu CJ, Cheng CY, Wu CW, Lau LI, Chou JC, Hsu WM. Fac-tors predicting intraocular pressure control after phacoemulsi-fication in angle-closure glaucoma. Arch Ophthalmol 2006; 124(10): 1390–4.

Moghimi S, Abdi F, Latifi G, Fakhraie G, Ramezani F, He M, et al. Lens parameters as predictors of intraocular pressure changes after phacoemulsification. Eye (Lond) 2015; 29(11): 1469–76.

Coh P, Moghimi S, Chen RI, Hsu CH, Masís Solano M, Porco T, et al. Lens position parameters as predictors of intraocular pres-sure reduction after cataract surgery in glaucomatous versus nonglaucomatous eyes. Invest Ophthalmol Vis Sci 2016; 57(6): 2593–99.

Issa SA, Pacheco J, Mahmood U, Nolan J, Beatty S. A novel index for predicting intraocular pressure reduction following cata-ract surgery. Br J Ophthalmol 2005; 89(5): 543–6.

Dooley I, Charalampidou S, Malik A, Loughman J, Molloy L, Beat-ty S. Changes in intraocular pressure and anterior segment morphometry after uneventful phacoemulsification cataract surgery. Eye (Lond) 2010; 24(4): 519–26.

Damji KF, Konstas AG, Liebmann JM, Hodge WG, Ziakas NG, Giannikakis S, et al. Intraocular pressure following phacoemul-sification in patients with and without exfoliation syndrome: a 2 year prospective study. Br J Ophthalmol 2006; 90(8): 1014–8.

Shaffer RN, Tour RL. A comparative study of gonioscopic methods. Am J Ophthalmol 1956; 41(2): 256‒65.

Lowe RF. Aetiology of the anatomical basis for primary angle-closure glaucoma. Biometrical comparisons between normal eyes and eye with and primary angle-closure glaucoma. Br J Ophthalmol 1970; 54(3): 161–9.

Lin SC, Masis M, Porco TC, Pasquale LR. Predictors of Intra-ocular Pressure After Phacoemulsification in Primary Open-Angle Glaucoma Eyes with Wide Versus Narrower Angles (An American Ophthalmological Society Thesis) [published correc-tion appears in Trans Am Ophthalmol Soc 2018 Jan 01; 115: T6C1]. Trans Am Ophthalmol Soc 2017; 115: T6.

Kovač B, Vukosavljević M, Janićijević MP, Resan M, Janković J. The prevalence of pseudoexfoliation syndrome and possible sys-temic associations in patients scheduled for cataract surgery at the Military Medical Academy in Belgrade. Vojnosanit Pregl 2014; 71(9): 839–44.

Jiang X, Torres M, Varma R. Variation in Intraocular Pressure and the Risk of Developing Open-angle Glaucoma: The Los Angeles Latino Eye Study. Am J Ophthalmol 2018; 188: 51‒9.

Elgin U, Şen E, Şimşek T, Tekin K, Yılmazbaş P. Early postop-erative effects of cataract surgery on anterior segment parame-ters in primary open-angle glaucoma and pseudoexfoliation glaucoma. Turk J Ophthalmol 2016; 46(3): 95–8.

Jimenez-Roman J, Lazcano-Gomez G, Martínez-Baez K, Turati M, Gulías-Cañizo R, Hernández-Zimbrón LF, et al. Effect of phacoemulsification on intraocular pressure in patients with primary open angle glaucoma and pseudoexfoliation glaucoma. Int J Ophthalmol 2017; 10(9): 1374–8.

Abdelghany AA, Sallam MA, Ellabban AA. Assessment of Ganglion Cell Complex and Peripapillary Retinal Nerve Fiber Layer Changes following Cataract Surgery in Patients with Pseudoexfoliation Glaucoma. Journal of Ophthalmology 2019; 2019: 8162825.

Irak-Dersu I, Nilson C, Zabriskie N, Durcan J, Spencer HJ, Cran-dall A. Intraocular pressure change after temporal clear corne-al phacoemulsification in normal eyes. Acta Ophthalmol 2010; 88(1): 131–4.

Hsu CH, Kakigi CL, Lin SC, Wang YH, Porco T, Lin SC. Lens position parameters as predictors of intraocular pressure re-duction after cataract surgery in nonglaucomatous patients with open angles. Invest Ophthalmol Vis Sci 2015; 56(13): 7807–13.

Pradhan S, Leffler CT, Wilkes M, Mahmood MA. Preoperative iris configuration and intraocular pressure after cataract sur-gery. J Cataract Refract Surg 2012; 38(1): 117‒23.

Moghimi S, Johari M, Mahmoudi A, Chen R, Mazloumi M, He M, et al. Predictors of intraocular pressure change after phacoemulsification in patients with pseudoexfoliation syn-drome. Br J Ophthalmol 2017; 101(3): 283‒9.

Shingleton BJ, Laul A, Nagao K, Wolff B, O'Donoghue M, Eagan E, et al. Effect of phacoemulsification on intraocular pressure in eyes with pseudoexfoliation: single-surgeon series. J Cata-ract Refract Surg 2008; 34(11): 1834–41.

Slabaugh M, Chen P, Smit B. Cataract surgery and IOP. Glau-coma Today 2013; May/June: 17–8.

Azuara-Blanco A, Burr J, Ramsay C, Cooper D, Foster PJ, Fried-man DS, et al. EAGLE study group. Effectiveness of early Lens extraction for the treatment of primary angle-closure Glaucoma (EAGLE): a randomised controlled trial. Lancet 2016; 388(10052): 1389–97.

Merkur A, Damji KF, Mintsioulis G, Hodge WG. Intraocular pressure decrease after phacoemulsification in patients with pseudoexfoliation syndrome. J Cataract Refract Surg 2001; 27(4): 528‒32.

Doganay S, Tasar A, Cankaya C, Firat PG, Yologlu S. Evaluation of Pentacam-Scheimpflug imaging of anterior segment param-eters in patients with pseudoexfoliation syndrome and pseudoexfoliative glaucoma. Clin Exp Optom 2012; 95(2): 218–22.

Yoo C, Amoozgar B, Yang KS, Park JH, Lin SC. Glaucoma se-verity and intraocular pressure reduction after cataract surgery in eyes with medically controlled glaucoma. Medicine (Balti-more) 2018; 97(42): e12881.

Bilak S, Simsek A, Capkin M, Guler M, Bilgin B. Biometric and intraocular pressure change after cataract surgery. Optom Vis Sci 2015; 92(4): 464–70.

DeVience E, Chaudhry S, Saeedi OJ. Effect of intraoperative factors on IOP reduction after phacoemulsification. Int Oph-thalmol 2017; 37(1): 63–70.