Eyeworld

EW CATARACT 38 November 2015 by Matt Young and Gloria D. Gamat EyeWorld Contributing Writers with subsequent cataract surgery. Further investigation into risk factors unique to glaucoma patients is warranted, particularly when weighing these risks with the poten- tial IOP-lowering and vision-related benefits of cataract surgery." Ophthalmologists react "Glaucoma doesn't directly interfere with the results [of cataract surgery]; it can alter the final visual outcome, however," said John D. Sheppard, MD, professor of ophthalmology, microbiology and molecular biology, and clinical director, Thomas R. Lee Center for Ocular Pharmacology, Eastern Virginia Medical School, Norfolk, Va. Thanks to medical literature, we know glaucoma treatment has long been associated with the develop- ment of cataracts and, consequently, increased rates of cataract surgery. The Veterans Affairs researchers not- ed that the role of cataract surgery on glaucoma management is gradu- ally changing, particularly in terms of intraocular pressure (IOP) control. In patients with ocular hyperten- sion, chronic open angle glaucoma, pseudoexfoliation, and angle-closure glaucoma, reduction of IOP after cataract surgery has been observed. Nevertheless, other patient pop- ulations have experienced worsen- Findings from this cohort study confirmed that visual outcomes and quality of life improved after cata- ract surgery in glaucoma patients and even in patients with high-risk glaucoma. These results are con- sistent with previously published research findings. But in those with glaucoma, the visual improvements are more modest compared to those without glaucoma. "We hypothesize that, in addition to postoperative inflamma- tion, topical glaucoma medication use and corneal changes may be influencing visual outcomes," the researchers explained. Furthermore, based on the overall findings of this large cohort study, the researchers conclud- ed that even if patients exhibit improved visual outcomes after cataract surgery, the increased risk of complications and lesser visual im- provement in glaucomatous eyes are causes for concern in elucidating the role of cataract surgery in glaucoma treatment management. "Worse IOP control has been observed after cataract surgery in patients who have had prior trabe- culectomy surgery," they reported. "Additionally, corneal endothelial cell loss has been noted after glauco- ma tube implantation, leaving eyes more vulnerable to corneal injury (12.4%) had a documented history of glaucoma, and the remaining cas- es (4,306 eyes) were used as controls. In the glaucoma group, 164 eyes were on more than 3 types of IOP-lowering medications or had prior incisional glaucoma surgery. These were categorized as high-risk glaucoma cases. Here's the overview of the results for glaucoma patients who underwent cataract surgery: • Glaucoma cases appear to be at in- creased risk for posterior capsular tear with vitrectomy. • Sulcus IOL implantation is more likely. • Postoperative inflammation is more likely. • They are at increased risk for ele- vated IOP. • Additional surgery within 30 days is more likely. • While BCVA and VFQ composite score improvements occurred, they were lesser than in non-glau- coma patients. • Fewer had a BCVA of 20/40 or bet- ter than non-glaucoma patients. Researchers suggested that traditionally, there has not been sufficient published information pertaining to the overall visual out- comes and complications brought about by cataract surgery in glauco- ma patients. Project highlights complicated glaucoma/ cataract relationship A s leading global causes of visual impairment, cat- aracts and glaucoma are age-related eye diseases that often co-exist. Nonetheless, treatments are prone to be discussed in isolation, particularly when focused on inno- vations in the treatment space. For instance, how refractive cataract surgery achieves successful visual results is examined independently from non-penetrating glaucoma techniques. While such discussions are necessary to examine new innova- tions in this subspecialty treatment space, the frequent co-existence of cataracts and glaucoma cannot be ignored. Earlier this year, the Veter- ans Affairs Ophthalmic Surgery Out- comes Data Project published data in the American Journal of Ophthal- mology about how cataract and glau- coma are frequently intertwined. It's complicated While numerous investigations have already evaluated the correlation between cataracts and glaucoma, re- sults of the Veterans Affairs Ophthal- mic Surgery Outcomes Data Project provide one of the most comprehen- sive data sets among retrospective cohort studies recently reported. The Veterans Affairs Ophthalmic Surgery Outcomes Database Pilot Program provided a unique platform to fully investigate and compare the clinical outcomes of cataract surgery from a large population of veterans with and without glaucoma. "We compared perioperative complications and pre- and postop- erative visual acuity, as well as vision-related quality of life as measured by the National Eye Institute-Visual Function Question- naire (NEI-VFQ) in patients with and without glaucoma undergoing cataract surgery in the Veterans Affairs Healthcare System," report- ed Angela Turalba, MD, assistant professor of ophthalmology, Harvard Medical School, Boston. Out of the 4,923 eyes included in the Ophthalmic Surgery Out- comes Database, 4,914 eyes were included for investigation; 608 Data available on patients with cataracts and glaucoma An eye with both a cataract and elevated IOP. Source: Pekka Virtanen

• Cover
• _GoBack
• _GoBack (1)