The Effect of Phacoemulsification on Intraocular Pressure in Eyes with Preexisting Glaucoma Drainage Implants

Wong, Sze H.; Radell, Jake E; Dangda, Sonal; Mavrommatis, Maria A; Yook, Eunmee; Vinod, Kateki; Sidoti, Paul A.; Panarelli, Joseph F.

doi:10.1016/j.ogla.2020.11.006

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…Wong and colleagues recently reported the outcomes of phacoemulsification in eyes with a pre-existing GDD, the majority (75%) being the BGI. The cumulative failure rate of 12% at 2 years was almost identical to our result, using a similar definition of failure 26…”

Section: Discussionsupporting

confidence: 89%

“…The cumulative failure rate of 12% at 2 years was almost identical to our result, using a similar definition of failure. 26 Cataract surgery alone has been reported to cause a decrease in IOP. [27][28][29][30] Proposed mechanisms for the IOP reduction include reduction of ciliary body aqueous production by capsular bag contraction, widening of the anterior chamber angle, and enhanced outflow by stretching of the trabecular meshwork.…”

Section: Discussionmentioning

confidence: 99%

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Intraocular Pressure Control Following Phacoemulsification in Eyes With Pre-existing Aurolab Aqueous Drainage Implant

Wijesinghe

Puthuran

Ramulu

et al. 2021

Journal of Glaucoma

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Purpose: The aim was to investigate intraocular pressure (IOP) control after phacoemulsification in adult glaucomatous eyes with a functioning nonvalved Aurolab Aqueous Drainage Implant (AADI) compared with eyes that did not have cataract extraction post-AADI. Methods: In this retrospective study, we reviewed records of 47 patients (47 eyes) who had a clear corneal phacoemulsification after AADI placement with a minimum of 2 years of follow up. The control group included 89 patients (89 eyes) who had a functional AADI at 1 year, minimum of 3 years of follow up post-AADI implantation, and no cataract extraction. The main outcome measure was failure (IOP >21 mm Hg or increased by >20% from prephacoemulsification level requiring at least 1 additional glaucoma medication, IOP ≤5 mm Hg, reoperation for glaucoma, or loss of light perception vision). Results: The median interval between AADI and phacoemulsification was 11.5 months (range: 4 to 68 mo), and the mean follow-up time after phacoemulsification was 35.6±6.4 months. The cumulative probability of failure was 14% (95% confidence interval=6%-31%) in the phaco group and 6% (95% confidence interval=3%-13%) in the control group at 2 years (P=0.11). Mean IOP was reduced from 16.5±4.5 mm Hg preoperatively to 15.4±4.7 mm Hg at 2 years after phacoemulsification (P=0.10). Mean LogMAR visual acuity improved from 1.1±0.6 preoperatively to 0.6±0.7 at 2 years after phacoemulsification (P<0.001). Conclusions: In eyes with a pre-existing AADI, phacoemulsification resulted in visual improvement without a significant rise in IOP or increased risk of AADI failure after 2 years follow up.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Intraocular Pressure Control Following Phacoemulsification in Eyes With Pre-existing Aurolab Aqueous Drainage Implant

Wijesinghe

Puthuran

Ramulu

et al. 2021

Journal of Glaucoma

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“…In addition, the average IOP among patients with combined surgery was greater than those with glaucoma drainage implants following cataract surgery (14 mm Hg vs. 12 mm Hg, respectively, P = 0.04). 37 Wong et al 38 described intermediate-term outcomes of 51 eyes of 45 patients who underwent cataract surgery following glaucoma drainage implant surgery. The authors reported a mean IOP of 12.6 mm Hg on an average of 2 glaucoma medications 24 months following phacoemulsification.…”

Section: Glaucoma Drainage Implantmentioning

confidence: 99%

“…Wong et al 38 described intermediate-term outcomes of 51 eyes of 45 patients who underwent cataract surgery following glaucoma drainage implant surgery. The authors reported a mean IOP of 12.6 mm Hg on an average of 2 glaucoma medications 24 months following phacoemulsification.…”

Section: Cataract Surgery Following Glaucoma Surgerymentioning

confidence: 99%

Cataract Extraction in Glaucoma

Rothman,

Lee

2023

International Ophthalmology Clinics

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closure glaucoma, followed by pseudoexfoliative glaucoma and then primary open-angle glaucoma. However, the authors noted the lack of high-quality evidence and suggested that additional data were needed to confirm these findings. 1 Data derived secondarily from randomized clinical trials support this relationship between cataract surgery and improved IOP. For example, Mansberger and colleagues 2 leveraged data from the Ocular Hypertension Treatment Study, a multicenter, prospective, randomized clinical trial that rigorously monitored IOP for patients with ocular hypertension assigned to either topical IOP medication or observation. 2 They found that nearly 40% of unmedicated eyes had a 20% or greater IOP reduction followed by cataract surgery. This difference was sustained for at least a year and diminished but persisted for additional 2 years. In addition, data derived from pivotal trials involving minimally invasive glaucoma surgery devices consistently demonstrate that those patients included in the control arm to receive stand-alone cataract surgery demonstrate improved average IOPs. The first-generation trabecular micro-bypass iStent (Glaukos Corporation, San Clemente, CA) found that, while eyes implanted with the iStent were more likely to meet various IOP thresholds at 12 months, 50% of eyes with stand-alone cataract surgery had a 20% or greater IOP reduction. 3 Similarly, the two-year results of the second-generation iStent reported a mean IOP reduction of 5.4 mm Hg from baseline and nearly 62% with 20% or greater IOP reduction for eyes receiving stand-along cataract surgery. 4 The long-term results for the Hydrus trabecular micro-stent (Alcon, Fort Worth, TX) also suggested sustained IOP reduction in eyes with stand-alone cataract surgery through 5 years. 5 Results from studies leveraging clinical registries echo the findings described previously. For example, the Swedish National Cataract Register prospectively collected data on 20,437 eyes that underwent stand-alone cataract surgery and calculated a mean IOP reduction of 1.46 mm Hg. Greater IOP reduction was associated with greater baseline IOP, older age, shorter eyes, and diagnoses of glaucoma and pseudoexfoliation. 6 Similarly, Wang et al. 7 created a text-processing algorithm that extracted data from electronic medical record free text on 4882 patients with 7574 cataract surgeries and found a sustained IOP reduction after cataract surgery through 14 months. Their multivariate analysis of predictors of IOP reduction found that, compared with eyes without glaucoma, diagnoses of primary open-angle glaucoma and narrow or closed angles had greater odds of IOP reduction. In addition, every 1 mm Hg increase in baseline IOP increased the odds of an IOP reduction after cataract surgery by 6%.The American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight) is a large, de-identified clinical data registry that consists of clinical and billing data on over 70 million unique patients with nearly 500 million unique patient encounters. 8 A rece...

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Effect of Lens Status on the Outcomes of Glaucoma Drainage Device Implantation

Stallworth,

Hekmatjah,

et al. 2024

Ophthalmology Glaucoma

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The Effect of Phacoemulsification on Intraocular Pressure in Eyes with Preexisting Glaucoma Drainage Implants

Cited by 3 publications

References 17 publications

Intraocular Pressure Control Following Phacoemulsification in Eyes With Pre-existing Aurolab Aqueous Drainage Implant

Intraocular Pressure Control Following Phacoemulsification in Eyes With Pre-existing Aurolab Aqueous Drainage Implant

Cataract Extraction in Glaucoma

Effect of Lens Status on the Outcomes of Glaucoma Drainage Device Implantation

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