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Rengaraj Venkatesh, Sabyasachi S Sengupta, Manas Nath, Alan L Robin, Pradeep Y Ramulu, Paul P Lee; Intraocular pressure reduction following phacoemulsification vs. manual small incision cataract surgery: A randomized controlled trial. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6461.
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© ARVO (1962-2015); The Authors (2016-present)
To compare reduction in intraocular pressure (IOP) and change in anterior chamber angle configuration between eyes undergoing phacoemulsification vs. manual small incision cataract surgery (MSICS) at 6 months follow up.
Prospective, randomized, double masked, parallel assignment clincal trial. Five hundred eyes of 500 participants between 40 – 70 years with normal IOP, gonioscopically open angles and age related cataract. Eyes underwent phacoemulsification or MSICS following a 1:1 randomization and allocation code. Best corrected vision (BCVA), IOP, comprehensive slit lamp evaluation and anterior segment optical coherence tomography (ASOCT) were performed at baseline and at 1, 3 and 6 months follow up.
There was equivalent reduction in IOP between eyes undergoing phacoemulsification 〈ΔIOP=2.7±2.9 mmHg〉 and MSICS 〈ΔIOP=2.6±2.6 mmHg〉. Widening of the angle opening distance at 500μ from scleral spur 〈Median ΔAOD 500=103μ, interquartile range=139μ〉 was also similar in both groups 〈p=0.28〉. Multivariable linear regression analysis showed that eyes with higher baseline IOP experienced significantly greater reduction in IOP at 6 months 〈ΔIOP=0.46 mmHg reduction with every 1 mmHg increment in baseline IOP, 95% confidence interval 〈CI〉= 0.4 to 0.5 mmHg, p<0.001〉. After adjusting for covariates, magnitude of widening of AOD 500 was not significantly associated with reduction in IOP 〈1.33 mmHg reduction with every 100µ increment in AOD 500, p=0.07〉. Baseline AOD 500 〈β= -0.60, 95%CI= -0.67 to -0.53〉 and AC depth were 〈β= 0.07, 95%CI= 0.04 - 0.1〉 significant predictors of widening of AOD 500 at 6 months.
Both phacoemulsification and MSICS lead to significant and equivalent reduction in IOP 6 months post surgery. Both surgeries produce similar changes in anterior chamber and angle parameters and higher IOP at baseline heralds greater IOP reduction. IOP reduction can be partly attributed to changes in angle and anterior chamber configuration but these parameters are unable to significantly predict how much IOP will drop at 6 months.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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