Association of Glaucoma and Surgical Outcomes Following Cataract Surgery in Veteran Population: Results from the Ophthalmic Surgical Outcomes Data Project

Abstract

 

Purpose

 

To estimate the association between glaucoma and the prevalence of complications and visual outcomes of cataract surgery in the veteran population.

 

Methods

 

A multicenter, retrospective cohort analysis from five VAMC sites. Clinical and demographic characteristics as well as outcome variables were investigated in patients who had cataract surgery. Outcomes analyzed included BCVA, minor and major complications, and intraoperative events. Fisher’s exact, chi square, McNemar’s tests, and t-test were used for statistic analysis. A longitudinal data analysis using multivariate logistic regression for the main outcome, and multivariable logistic regression models for secondary outcomes were performed adjusting for potential confounders.

 

Results

 

Of the 4899 eyes, 608 (12.4%) had glaucoma. Mean age was 74.5±9.4 in patients with glaucoma compared to 70.0±9.6, without it (p<0.0001). There were no differences in ASA class, diabetes, diabetic retinopathy, hypertension and gender. PXF and small pupil were higher in patients with glaucoma (p<0.0001). The percentage of eyes that improved was higher in those without glaucoma (91.4%) compared to that seen in those with glaucoma (86.4%). The prevalence of posterior capsular tear (p=0.027), vitreous prolapse (p=0.03) and anterior vitrectomy (p=0.007) were higher in eyes with glaucoma. More eyes in the glaucoma group were identified as having minor and major complications (p<0.0001), (p<0.0001), vitreous loss (p=0.03), stromal edema (p=0.045), and post- operative inflammation (p<0.0001). We also observed significantly higher proportion of postoperative IOP of >25 mmHg (p<0.0001) as well as <5 mmHg at one week (p=0.011) in patients with glaucoma. After accounting for confouders, we found a significant association between glaucoma and BCVA as well as significant differences in intraoperative events, minor and major complications between groups.

 

Conclusions

 

We found that glaucoma is associated with a significantly higher prevalence of intraoperative events, minor, and major complications. Though the presence of glaucoma is associated with a lower percentage of eyes improved, the change in BCVA is still significant in this group after cataract. The glaucoma group had a higher intraocular postoperative pressure, suggesting the possible need of a more aggressive IOP lowering therapy in glaucomatous eyes.

 

Keywords: 445 cataract • 462 clinical (human) or epidemiologic studies: outcomes/complications • 463 clinical (human) or epidemiologic studies: prevalence/incidence