EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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EW RESIDENTS 108 October 2014 help us better counsel patients about therapeutic outcomes. Brown et al.'s study along with past studies clearly support that cataract surgery continues to evolve as an important adjunct to the treatment and management of glaucoma. EW References 1. Shrivastava A, Singh K. The impact of cataract surgery on glaucoma care. Curr Opin Ophthalmol. 2014;25(1):19–25. 2. Poley BJ, Lindstrom RL, Samuelson TW. Long-term effects of phacoemulsific tion with intraocular lens implantation in normotensive and ocular hypertensive eyes. J Cataract Refract Surg. 2008;34(5):735–42. 3. Poley BJ, Lindstrom RL, Samuelson TW, Schulze R. Intraocular pressure reduction after phacoemulsific tion 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. 4. Issa SA, Pacheco J, Mahmood U, Nolan J, Beatty S. A novel index for predicting intra- ocular pressure reduction following cataract surgery. Br J Ophthalmol. 2005;89(5):543–6. 5. Yudhasompop N, Wangsupadilok B. Effects of phacoemulsific tion and intraocular lens implantation on intraocular pressure in primary angle closure glaucoma (PACG) pa- tients. J Med Assoc Thai. 2012;95(4):557–60. 6. Lai JS, Tham CC, Chan JC. The clinical out- comes of cataract extraction by phacoemul- sific tion in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract: a prospective case series. J Glaucoma. 2006;15(1):47–52. 7. Mansberger SL, Gordon MO, Jampel H, et al. Reduction in intraocular pressure after cataract extraction: the Ocular Hypertension Treatment Study. Ophthalmology. 2012;119(9):1826–31. 8. Parrish RK II, Minckler DS, Lam D, et al. Guidelines of design and reporting of glauco- ma surgical trials. In: Shaarawy TM, Sherwood MB, Grehn F, editors. Guidelines on Design and Reporting of Glaucoma Surgical Trials. World Glaucoma Association; The Hague, Netherlands: Kugler; 2008. p. 8–9. 9. Shams PN, Foster PJ. Clinical outcomes after lens extraction for visually significant cataract in eyes with primary angle closure. J Glaucoma. 2012;21(8):545–50. 10. Moghimi S, Latifi G, Amini H, et al. Cataract surgery in eyes with filtered prima y angle closure glaucoma. J Ophthalmic Vis Res. 2013;8(1):32–8. 11. Chen PP, Weaver YK, Budenz DL, Feuer WJ, Parrish RK II. Trabeculectomy function after cataract extraction. Ophthalmology. 1998;105(10):1928–35. 12. Yang HS, Lee J, Choi S. Ocular biometric parameters associated with intraocular pressure reduction after cataract surgery in normal eyes. Am J Ophthalmol. 2013;156(1):89–94.e1. Contact information Lauer: lauera@ohsu.edu is more likely to have a greater (or lesser) magnitude of IOP reduction following cataract surgery? Assessing whether the etiology of the narrow angles affects IOP reduction after cataract surgery would have been interesting. For example, the IOP in eyes with peripheral anterior synechiae may respond differently to cataract surgery compared to the IOP in eyes with phacomorphic glaucoma. A recent study by Shams and Foster 9 described the effect of cataract surgery in patients with primary angle closure, 65% of which had glaucomatous optic neuropa- thy (GON). Similar to Brown et al., Shams and Foster found that preop- erative IOP was correlated with the magnitude of IOP change following cataract surgery. The authors addi- tionally found that a larger number of preop glaucoma medications, narrow preop iridotrabecular angle width, greater extent of peripheral anterior synechiae formation, and evidence of GON were associated with greater IOP reduction following cataract surgery. In order to minimize contro- versy and maintain a data set with fewer variables, Brown et al. were insightful to exclude patients with prior intraocular surgery in their study. A recent prospective interven- tional case series by Moghimi et al. 10 found that cataract surgery caused a significant reduction in IOP in 37 patients with primary ACG, all of whom had prior filtering surge y. This study additionally found that the degree of IOP reduction was cor- related with higher preoperative IOP (r=0.85, P<0.001), shallower preop anterior chamber (AC) depth (r= –0.38, P=0.01), and greater changes in AC depth following cataract surgery (r= –0.39, P=0.01). This finding is in contrast to patients with POAG in which cataract extraction following filtering surge y is often associated with an increase in IOP due to subsequent bleb dysfunction. 11 The mechanism of IOP reduc- tion following cataract surgery has not been clearly defined, howeve , authors have suggested that IOP improves due to anterior chamber deepening and angle widening following cataract extraction but did not support or refute this. A recent prospective observational case series of 999 normotensive patients by Yang et al. found that changes in ACD, angle opening distance, and anterior chamber area following uncomplicated phacoemulsification were more strongly associated with IOP reduction than preoperative IOP. 12 The IOP-lowering effects of cataract surgery were confirmed by Brown et al. Importantly, they confirmed that among patients with CACG or narrow angles, those with higher preoperative IOP and shallower ACD are most likely to experience IOP reduction follow- ing cataract surgery. While this study suggests that the degree of IOP reduction in eyes with narrow angles or CACG may be predicted by preoperative IOP, the limitations inherent to a retrospective analysis cautions us to interpret with care the results of this study to guide clinical management. Further investiga- tion on this topic with prospective study design and data acquisition would help us better understand the impact of cataract surgery in the management of glaucoma and 10201-A Trademark St. Rancho Cucamonga, CA 91730-5850 Phone: (909) 481-0011 | Toll Free: (800) 782-6534 Fax: (909) 481-4481 One of the largest selections of ophthalmic cannulae available for cataract and refractive surgery PVA Eye Spears Cannulae Knives For Over 25 Years Eagle Labs has been a Leading Manufacturer of Ophthalmic Single - Use Cannulae and Micro Surgical Knives All Eagle Products Are Made in the USA www.eaglelabs.com Samples available upon request Cataract surgery continued from page 107