INTRA-OCULAR PRESSURE EVOLUTION AFTER CATARACT SURGERY, PERCEPOLIS STUDY REPORT NUMBER 4. A RANDOMIZED CLINICAL TRIAL.

Abstract

Purpose : The PERCEPOLIS trial is a prospective, controlled, randomized study that compares two surgical methods of cataract (Divide and conquer versus nucleus subluxation) in terms of post-op endothelial cells loss. In this study we are interested in the intra-ocular pressure (IOP).

Methods : 241 patients' eyes were analyzed, were included patients underwent cataract surgery with visual acuity less than 0.2 logMAR. IOP was measured pre-op and at 3 months post-op, all glaucomatous patients were excluded, and none received anti-glaucomatous treatment post-op. The primary study endpoint was the IOP variation between pre-op and at 3 months post-op. The secondary study endpoints were factors associated with pre-op and 3 months post-op IOP variation. Those factors included: Implant’s power lower or higher than to 21D, age, sex, surgical technique, pre-op IOP, the hardness of the nucleus and finally the EPT (effective phacoemulsification time).

Results : Patients with a pre-op IOP of 10-14mmHg decreased their post-op IOP by -1 mmHg (SD 2, P<0.001), those with an IOP of 15-19mmHg decreased by -2 mmHg (SD 2, P <0.001), those with an IOP of 20-24mmHg decreased by -4 mmHg (SD 2, P <0.001), and those with an IOP of 25-29mmHg decreased by -9 mmHg (SD 2, P <0.001). For implant power lower or higher than 21D, the evolution of the IOP at 3 months was similar: -2 mmHg (SD 3, P = 0.83). In multivariate analysis, postoperative IOP at 3 months was significantly lowered compared to pre-op (P <0.001). In older patients, post-op IOP seems to decrease more than in younger patients (P = 0.02), the same results were observed for men (-2.6 mmHg SD 2.8, P = 0.05) compared to women (-2.2 mmHg SD 2.9, P = 0.05).The surgical technique (P = 0.32), the hardness of the nucleus (P = 0.58) and the EPT (P = 0.46) don’t seem to have any influence on the variation of IOP at 3 months post-op.

Conclusions : We find that all patients decreased their post-op IOP at 3 months, and even more those who had a higher pre-op IOP. A long-term randomized study would be interesting to confirm the persistence of the lowered IOP and its impact on potential future glaucomatous patients.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.