Phacoemulsification with IOL implantation should be considered an option for treating eyes with glaucoma and high IOP

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• Marc D. Myers, O.D.

Numerous studies have been conducted to investigate the change in intraocular pressure (IOP) after phacoemulsification with intraocular lens (IOL) implantation. These studies have produced widely varying results, with reduction in IOP ranging from less than 2 mmHg to greater than 13 mmHg. The authors of this study conducted a previous retrospective study in 2008 comparing normotensive and ocular hypertension (OHT) eyes, which found that the postoperative IOP reduction was proportional to the preoperative IOP after the eyes were stratified into 5 groups according to their preoperative IOP.

This retrospective study included 124 eyes with glaucoma that underwent phacoemulsification with IOL implantation. The study did include both surgical and nonsurgical glaucoma patients. IOP was measured before cataract surgery, 1 year after surgery, and at the final examination. Eyes were then placed into one of the previously mentioned 5 groups as follows: 29 to 23 mmHg, 22 to 20 mmHg, 19 to 18 mmHg, 17 to 15 mmHg, and 14 to 5 mmHg.

In all eyes, the mean IOP decrease from preoperative state to final recording was 17%. The postoperative IOP reduction was proportional to the preoperative IOP reading. Therefore, eyes with the highest preoperative IOP exhibited the largest amount of IOP decrease. The group with the highest mean preoperative IOP showed a 34% reduction of IOP at the final recording, a mean reduction of 8 mmHg. The group with the lowest preoperative IOP showed a 16% elevation in IOP at the final recording, a 1.9-mmHg increase. IOP reductions seen at 1 year were maintained to the final recording. All eyes in the highest preoperative IOP group showed a decrease in IOP, whereas 56% of eyes in the lowest preoperative IOP group actually showed an increase in IOP.

According to this study, it appears that eyes with higher preoperative IOP levels exhibit greater postoperative IOP reduction. It also appears that eyes with the lowest preoperative IOP showed an insignificant postoperative IOP reduction or an IOP elevation. Therefore, the IOP reduction after phacoemulsification with IOL implantation was proportional to the preoperative IOP. The authors conclude that phacoemulsification with IOL implantation should be considered an option for treating eyes with glaucoma and high IOP. They also add that the beneficial effects of treating glaucomatous eyes with low preoperative IOP are not evident. The studies performed by the authors on glaucomatous and nonglaucomatous eyes found that the IOP reductions found at 1 year postoperatively were maintained through the 10-year study period. They also suggest that phacoemulsification with IOL implantation could be considered in forestalling the development of glaucoma in those individuals identified by the Ocular Hypertension Treatment Study results. It may be beneficial for practitioners to consider phacoemulsification with IOL implantation in many glaucoma patients, particularly those exhibiting suboptimal IOP control.