Abstract
Purpose :
To evaluate intraocular pressure (IOP) after phacoemulsification in open angle glaucoma (OAG) patients with medically uncontrolled glaucoma and/or with severe visual field (VF) loss.
Methods :
Review of all glaucoma patients without prior incisional glaucoma surgery undergoing phacoemulsification by a single surgeon (PPC) between August 2000 and July 2014. Medically uncontrolled glaucoma was defined as IOP > 21 mmHg despite maximally tolerated medications or requiring more than 3 topical drugs for IOP control, and severe VF loss was defined as baseline VF mean deviation (MD) ≤ -12dB. Patient charts were reviewed to obtain demographic information, and pertinent preoperative and postoperative data.
Results :
43 eyes (43 patients) were included in the study. The average age was 70.87 ± 11.43 years, 22 (51.2%) were male, and 32 (74.4%) were caucasian. The average VF MD was -12.81 ± 8.78 dB and pattern standard deviation was 7.43 ± 4.52 dB. The average preoperative IOP of 15.1 ± 4.2 mmHg decreased to 14.1 ± 3.6 mmHg at 1 year (p =0.111, paired t-test), and the average preoperative number of medications of 3.42 ± 1.11 decreased to 2.84 ± 1.32 (p=0.030). Fifteen eyes (34.9%) had higher IOP at postoperative year 1 without medication change, or required additional medications or surgical treatment for IOP control within the first year postoperatively, including one eye (2.3%) that required laser trabeculoplasty and two eyes (4.7%) that required trabeculectomy. Intraocular pressure change at 1 year after surgery was not related to age, sex, axial length, anterior chamber depth, gonioscopy grade, central corneal thickness, preoperative number of medications, previous laser treatment, or IOP spike at day 1 after surgery (p≥0.107). No cases of severe loss of central vision (“snuff-out”) occurred. Visual acuity was stable (within one line) in 21 eyes (48.8%), improved by two or more Snellen lines in 19 eyes (44.2%), and worsened by two or more Snellen lines in 3 eyes (7.0%).
Conclusions :
Phacoemulsification resulted in non-significant IOP change in open angle glaucoma patients with medically uncontrolled glaucoma or with severe VF loss. About 35% of patients experienced an increase in IOP or required more aggressive treatment to control IOP postoperatively, including about 5% who required trabeculectomy within the first year after phacoemulsification.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.