Assessment of intra and postoperative complications of cataract surgery in glaucoma suspects

Abstract

Purpose : Glaucomatous eyes have increased risk of complications associated with cataract surgery. We performed a retrospective, observational clinical study to assess whether similar intra and postoperative complications are observed in glaucoma suspects.

Methods : Cases of cataract extraction by phacoemulsification performed by surgeons on the Comprehensive Ophthalmology Service at an academic practice in Boston, MA between 1/1/14-12/31/14 were reviewed. Perioperative information was collected. Glaucoma suspects were identified and monitored for intraoperative complications and postoperative complications at day 1 (POD1), week 1 (POW1), and month 1 (POM1) exams. Relative risks of complications were calculated in glaucoma suspects versus non-glaucoma and non-glaucoma suspect control cases.

Results : 950 cataract cases were reviewed. 9 patients with planned combined cataract extraction and pars plana vitrectomy were excluded. Of 941 remaining cases, 166 were glaucoma suspects in the operative eye, with 732 controls. Patients ranged from 44-97 years old with 109 (65.7%) women. The most common reason for inclusion as a glaucoma suspect was increased cup to disc (C/D) ratio or asymmetry in 94 patients (56.6%). 34 (20.5%) had ocular hypertension (OHTN) without C/D changes, 12 (35.3%) of whom were on drops to control intraocular pressure (IOP). 19 (11.4%) had narrow angles, and 15 (9.0%) had other pathology (e.g. pigment dispersion, visual field defects). Glaucoma suspects had no increased relative risk of anterior or posterior capsular rents, anterior vitrectomy, or sulcus lens placement during surgery, compared to controls. At POD1, 52 glaucoma suspect patients (31.3%) had elevated IOP, including 35 with no history of OHTN. At this visit, glaucoma suspects trended toward increased risk of change in steroid drop regimen or addition of IOP drops, however these did not reach statistical significance (RR=1.37, p=0.38; RR=1.32, p=0.31, respectively). There was no increased risk of change in steroid or NSAID drops regimen at POW1, or retinal detachment or macular edema at POM1.

Conclusions : These results suggest that unlike glaucoma patients, glaucoma suspects undergoing routine cataract surgery do not have increased risk of intraoperative complications. Our results do suggest a propensity for postoperative IOP elevation among glaucoma suspects, with a timeline that cannot be explained by corticosteroid responsiveness.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.