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Effect of phacoemulsification cataract surgery on intraocular pressure in early glaucoma: a prospective multi-site study


Qassim, A and Walland, MJ and Landers, J and Awadalla, M and Nguyen, T and Loh, J and Schulz, AM and Ridge, B and Galanopoulos, A and Agar, A and Hewitt, AW and Graham, SL and Healey, PR and Casson, RJ and Craig, JE, Effect of phacoemulsification cataract surgery on intraocular pressure in early glaucoma: a prospective multi-site study, Clinical and Experimental Ophthalmology, 48, (4) pp. 442-449. ISSN 1442-6404 (2020) [Refereed Article]

Copyright Statement

Copyright 2020 Royal Australian and New Zealand College of Ophthalmologists

DOI: doi:10.1111/ceo.13724


Importance: Cataract and primary open-angle glaucoma (POAG) commonly co-exist, and cataract surgery is thought to reduce intraocular pressure (IOP), the major modifiable risk factor of POAG.

Background: Previous studies exploring the effect of cataract surgery on IOP are limited by retrospective design, lack of a control group, medication use and washout and loss to follow up.

Design: Prospective, multicentre, matched case-control Australian study.

Participants: 171 eyes of 108 POAG patients who underwent cataract surgery, matched to 171 control eyes.

Methods: Serial longitudinal IOP measurements were compared before and after cataract surgery, and relative to the controls. A mixed-effect model was used for the longitudinal data.

Main Outcome Measures: Change in IOP.

Results: The mean follow-up time was 4.8 (1.4) years. Cataract surgery reduced mean IOP by 2.22 mmHg (95% confidence interval: 1.93-2.52 mmHg, P < .001) with 59 eyes (34%) achieving at least 3 mmHg reduction. Compared to matched controls, the mean reduction in IOP was 1.75 mmHg (95% confidence interval 1.15-2.33 mmHg; P < .001). Higher preoperative IOP and being on fewer topical glaucoma medications preoperatively were strongly predictive of a larger IOP reduction in a multivariable model. Anterior chamber depth was not associated with IOP reduction. Eyes with preoperative IOP ≥24 mmHg had a mean IOP reduction of 4.03 mmHg with 81% experiencing at least 3 mmHg reduction. Sub-analysis of medication na´ve and pseudoexfoliation patients showed similar results.

Conclusions and Relevance: Cataract surgery has a confirmed effect in reducing IOP in a "real world" setting of early glaucoma patients.

Item Details

Item Type:Refereed Article
Keywords:biometry, cataract, cataract surgery, open-angle glaucoma, phacoemulsification
Research Division:Biomedical and Clinical Sciences
Research Group:Ophthalmology and optometry
Research Field:Ophthalmology
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Hewitt, AW (Professor Alex Hewitt)
ID Code:138809
Year Published:2020
Web of Science® Times Cited:6
Deposited By:Menzies Institute for Medical Research
Deposited On:2020-04-30
Last Modified:2022-08-29

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