Cataract surgery reduces intraocular pressure but not posture-induced intraocular pressure changes in patients with angle-closure glaucoma

Abstract Cataract surgery leads to a sustained decrease in sitting intraocular pressure (IOP) in patients with angle-closure glaucoma (ACG). The purpose of this study is to evaluate whether cataract surgery can also reduce postural IOP changes. We prospectively examined 106 eyes from 53 patients with narrow angles scheduled for phacoemulsification. IOP was measured in the sitting, supine, and lateral decubitus positions using an ICare rebound tonometer before and 1 week, 1 month, and 3 months postoperatively. The mean baseline IOP in the sitting and lateral decubitus positions was 17.9 ± 4.8 mmHg and 21.43 ± 6.44 mmHg, which significantly reduced to 13.52 ± 3.8 and 17.46 ± 3.62, respectively, 3 month postoperatively (p < 0.001). However, postural IOP change (lateral decubitus minus sitting) at 3 months postoperatively was not significantly different from that at the baseline (3.17 ± 2.63 vs. 3.53 ± 3.38 mmHg, p = 0.85). Postural IOP change was not associated with preoperative sitting IOP, anterior chamber depth, axial length, fixed pupil, or presence of glaucomatous optic neuropathy. Patients with higher preoperative IOP exhibited greater IOP reduction after cataract surgery in every posture (p < 0.0001). In conclusion, cataract surgery reduces IOP in all postures among patients with ACG; however, it does not reduce the magnitude of postural IOP change.

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Single-pass four-throw pupilloplasty for secondary angle-closure glaucoma associated with silicon oil tamponade

European Journal of Ophthalmology ◽

10.1177/1120672118780809 ◽

2018 ◽

Vol 29 (5) ◽

pp. 561-565 ◽

Cited By ~ 1

Author(s):

Priya Narang ◽

Ashar Agarwal ◽

Amar Agarwal

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Intraocular Pressure ◽

Anterior Chamber ◽

Anterior Segment ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Single Pass ◽

Silicon Oil ◽

The Mean

Purpose: To describe the feasibility and efficacy of performing single-pass four-throw pupilloplasty for secondary angle-closure glaucoma post silicon oil tamponade. Methods: The procedure was performed in five eyes of five patients. All the cases underwent silicon oil removal with single-pass four-throw pupilloplasty. Single-pass four-throw procedure involves a single pass of needle through the iris tissue that is to be apposed followed by taking four throws by passing the suture end through the loop that is withdrawn from the anterior chamber as in a modified Siepser’s slip-knot technique. Both the suture ends are pulled and this leads to sliding of the loop into the anterior chamber. Surgical pupilloplasty stretches the peripheral iris tissue and helps in breaking the peripheral anterior synechia. Intraoperative gonioscopy and anterior segment optical coherence tomography were performed in all the cases. Results: Intraoperative gonioscopy and anterior segment optical coherence tomography demonstrated opening of the anterior chamber angles with breakage of peripheral anterior synechia. The mean preoperative and postoperative best-corrected visual acuity in logarithm of minimum angle of resolution was 1.24 ± 0.23 and 0.56 ± 0.18, respectively (p < 0.001). The mean preoperative and postoperative intraocular pressure was 38.2 ± 4.97 and 13.0 ± 2.35 mm Hg, respectively. There was a significant decrease in intraocular pressure and marked improvement in visual acuity in all the cases. Conclusion: Surgical pupilloplasty helps to relieve the post-silicon oil-induced secondary angle-closure glaucoma by breaking peripheral anterior synechia and significantly opening the anterior chamber angles.

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Outcomes of Small Size Ahmed Glaucoma Valve Implantation in Asian Chronic Angle-Closure Glaucoma

Journal of Clinical Medicine ◽

10.3390/jcm10040813 ◽

2021 ◽

Vol 10 (4) ◽

pp. 813

Author(s):

Ke-Hao Huang ◽

Ching-Long Chen ◽

Da-Wen Lu ◽

Jiann-Torng Chen ◽

Yi-Hao Chen

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Anterior Chamber ◽

Angle Closure Glaucoma ◽

Adult Patients ◽

Angle Closure ◽

Posterior Chamber ◽

Ahmed Glaucoma Valve ◽

Probability Of Success ◽

The Mean

For chronic angle-closure glaucoma (ACG), Ahmed glaucoma valve (AGV) is a useful drainage device for intraocular pressure (IOP) control but there are few reports discussing the outcomes of small size AGV in adult patients. This retrospective study involved 43 Asian adult patients (43 eyes) with chronic ACG. All patients had undergone small size AGV insertion and were divided into anterior chamber (AC) group and posterior chamber (PC) group. In the AC group, tube was inserted through sclerectomy gap into the anterior chamber. In the PC group, tube was inserted into posterior chamber through a needling tract. Outcome measures were intraocular pressure (IOP), visual acuity, number of antiglaucoma medications, survival curve and incidence of complications. In total, 43 eyes of 43 patients, 24 in the AC group and 19 in the PC group, were reviewed. The mean follow-up period was 28.5 months (95% confidence interval: 25.5–31.4). Mean IOP had significantly decreased following AGV insertion. The Kaplan–Meier survival analysis demonstrated a probability of success at 24 months of 67.4% for qualified success and 39.5% for complete success. There were no significant differences between the AC and PC groups in terms of the mean IOP, cumulative probability of success, visual acuity change or antiglaucoma medication change, except IOP at 1-day and 1-month mean IOP. The most common complications noted was hyphema in the PC group. For adult chronic ACG patients, small size AGV insertion could be effective at lowering IOP. Besides, tube insertion into AC with sclerectomy may prevent the hypertensive phase in the early postoperative period.

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Long Term Outcomes of Cataract Surgery in Severe and End Stage Glaucoma with Controlled IOP:A Retrospective Study

10.21203/rs.2.17700/v2 ◽

2020 ◽

Author(s):

Lin Fu ◽

Yau Kei Chan ◽

Junhua Li ◽

Li Nie ◽

Na Li ◽

...

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Cataract Surgery ◽

Final Visual Acuity ◽

Angle Closure ◽

Mean Deviation ◽

Primary Angle Closure Glaucoma ◽

The Mean ◽

End Stage

Abstract Background: To investigate the long term surgical outcomes of cataract surgery in severe and end stage glaucoma patients with preoperative intraocular pressure less than 21mmHg, and to detect the associated factors.Methods: A retrospective study of primary angle closure glaucoma patients was conducted on who underwent cataract surgery or combined with goniosynechialysis from March 2015 to April 2018. Main outcome measures were visual acuity, intraocular pressure, number of glaucoma medications and complications. Results: Sixteen patients (19 eyes) were included. The mean age was 64.89 ± 11.68 years and the mean followed up duration was 21.89 ± 7.85 months. The final visual acuity was significantly improved from 0.69 ± 0.55 to 0.46 ± 0.52 logMAR , within 12 (63.2%) eyes improved, 4 (21.1%) eyes kept unchanged, and 3 (15.8%) eyes reduced. Linear regression analysis indicated that higher mean deviation, higher visual field index and lower glaucoma stage associated with better final visual acuity (r = -0.511, r = -0.493, r = 0.537 respectively). Moreover, the final number of medications were reduced from 1.26 ± 0.99 to 0.26 ± 0.56 (p < 0.01). The mean intraocular pressure was not significantly reduced with the final IOP of 14.48 ± 3.74 mmHg (p = 0.97). While the eyes with intraocular pressure above 15 mmHg was decreased to 6 (31.6%) eyes compared to 10 (52.6%) eyes at baseline. Moreover, the number of eyes free of medications was increased from 4 (21.1%) preoperatively to 15 (78.9%) eyes postoperatively.Conclusions: Final visual acuity was significantly improved in the severe and end stage primary angle closure glaucoma patients and the number of eyes came off medications increased by 57.8% after cataract surgery. Preoperatively, the glaucoma stage, mean deviation and visual field index are important parameters to predict the final visual acuity after cataract surgery.

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Nasal trabeculo-ciliary angle and relative lens vault as predictors for intraocular pressure reduction following phacoemulsification

European Journal of Ophthalmology ◽

10.1177/11206721211055033 ◽

2021 ◽

pp. 112067212110550

Author(s):

Riham SHM Allam ◽

Karim A Raafat ◽

Mai Nasser Abd Elmohsen

Keyword(s):

Intraocular Pressure ◽

Open Angle Glaucoma ◽

Anterior Chamber Depth ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Pressure Reduction ◽

Open Angle ◽

Lens Position ◽

Intraocular Pressure Reduction ◽

Lens Vault

Purpose To evaluate quantitative relationships between biometric measurements and expected intraocular pressure reduction following phacoemulsification. Design A prospective, comparative clinical study. Methods Forty nine candidates for phacoemulsification were included. Intraocular pressure was measured preoperatively and after 7 and 30 days. Ocular biometrics were measured using optical biometry and ultrasound biomicroscopy preoperatively and 1 month postoperatively. Results Patients were sub-grouped into open-angle glaucoma (12 eyes), angle-closure glaucoma (18 eyes), and cataract-only groups (19 eyes). The mean intraocular pressure reduction was −1.67 ± 2.73, −13.11 ± 7.98, and −7.50 ± 3.58 mmHg in the cataract-only, angle-closure glaucoma, and open-angle glaucoma groups ( p = 0.001). The delta-intraocular pressure at day 7 showed positive correlations with lens vault and relative-lens vault ( p = 0.005 and 0.001). It showed negative correlations with lens position, relative-lens position, anterior chamber depth, aqueous depth, and nasal and temporal angles in addition to lens thickness, anterior vault, nasal trabeculo-ciliary angle, and temporal-trabeculo-ciliary angle at the end of the follow-up period. Regression analysis revealed significant associations between preoperative intraocular pressure and both nasal-trabeculo-ciliary angle and anterior vault ( p = 0.038 and 0.019) and delta-intraocular pressure and both nasal-trabeculo-ciliary angle and relative-lens vault ( p = 0.001 and ≤0.001) with an area under the curve of 0.71 for relative-lens vault. For every degree decrease in nasal-trabeculo-ciliary angle, there was an expected 0.33 mmHg intraocular pressure reduction with no expected change if nasal-trabeculo-ciliary angle decreased to <22°. Conclusions The relationship between anterior-segment-biometrics could determine intraocular pressure behavior after phacoemulsification. The preoperative nasal-trabeculo-ciliary angle and relative-lens vault could be significant predictors for postoperative intraocular pressure reduction.

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Intraocular Pressure Changes during Femtosecond Laser-Assisted Cataract Surgery: A Comparison between Two Different Patient Interfaces

Journal of Ophthalmology ◽

10.1155/2019/5986895 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Chiara De Giacinto ◽

Rossella D’Aloisio ◽

Alessandro Bova ◽

Tommaso Candian ◽

Alberto Armando Perrotta ◽

...

Keyword(s):

Intraocular Pressure ◽

Femtosecond Laser ◽

Cataract Surgery ◽

Soft Contact ◽

Soft Contact Lens ◽

Significant Difference ◽

The Mean ◽

Group 2 ◽

Pressure Changes ◽

Group 1

Purpose. The aim of this retrospective cohort study was to evaluate intraocular pressure (IOP) changes during femtosecond laser-assisted cataract surgery (FLACS) using two different patient interface systems. Methods. 116 eyes of 116 patients scheduled for cataract surgery were divided into 2 groups: group 1 (61 eyes) and group 2 (55 eyes) underwent FLACS using Catalys Laser with fluid interface (liquid optics interface, LOI) and LenSx Laser with curved interface and soft contact lens (SoftFit), respectively. IOP was assessed using a portable rebound tonometer (Icare®) preoperatively, after docking, immediately after surgery, at one and seven days postoperatively. Results. In group 1, the mean IOP (±SD) was 14.1 ± 0.4 mmHg before surgery, 33.2 ± 1.1 mmHg after docking, and 21.4 ± 0.9 mmHg immediately after surgery. In group 2, the mean IOP was 13.8 ± 0.4 mmHg before surgery, 24.2 ± 1.4 mmHg after docking, and 20.2 ± 1.2 mmHg immediately after surgery. After the docking procedure, a statistically significant increase in IOP from the baseline was found in both groups (p<0.001). Moreover, no statistically significant difference in IOP measured at 1 and 7 days postoperatively was observed compared with the preoperative values (p>0.05) using both laser platforms. No intraoperative and postoperative complications were observed. Conclusions. FLACS suction phase resulted in a transient increase of IOP in both groups, especially with the LOI system, and it is probably related to the greater pressure of a suction ring and suction generated through the vacuum, independently from the effect of femtosecond laser itself.

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Efficacy of latanoprost in management of chronic angle closure glaucoma

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v1i1.3671 ◽

1970 ◽

Vol 1 (1) ◽

pp. 32-36 ◽

Cited By ~ 1

Author(s):

S Kumar ◽

A Malik ◽

M Singh ◽

S Sood

Keyword(s):

Intraocular Pressure ◽

Posterior Segment ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Slit Lamp ◽

Treatment Results ◽

Once Daily ◽

Significant Difference ◽

The Mean ◽

Baseline Examination

Background: Chronic angle closure glaucoma is often managed surgically. Aim: To study the effect of Latanoprost 0.005% on intraocular pressure in subjects diagnosed as having chronic angle closure glaucoma. Materials and methods: Forty patients participated in the study. Baseline examination included visual acuity, refraction, slit-lamp examination, intraocular pressure, anterior and posterior segment examination, gonioscopy and perimetry. Patients were treated with Latanoprost 0.005% once daily at bedtime. IOP was recorded at baseline, 2weeks, 4 weeks, 8 weeks and 12 weeks after starting the treatment. Results: The mean age of the study sample was 56.45 years (40-70 years). There were 18 males and 22 females in the study. Mean IOP at baseline was 24.55±3.63. Mean IOP decreased to 17.27±3.19 at 2 weeks, 15.27±3.07 at 4 weeks, 14.60±3.06 at 8 weeks and 14.47±2.66 at 12 weeks. There was a statistically significant reduction in mean IOP (41.03%) at 12 weeks as compared to those of the baseline IOP (p=0.000). There was no significant difference in IOP reduction in eyes with different degrees of angle closure by peripheral anterior synechiae. Conclusion: Latanoprost, a prostaglandin analogue, is effective in reducing IOP in chronic angle closure glaucoma patients and its efficacy is not affected by the degree of angle closure by peripheral anterior synechiae. Key words: latanoprost; chronic angle closure glaucoma; intraocular pressure; peripheral anterior synechiae DOI: 10.3126/nepjoph.v1i1.3671 Nep J Oph 2009;1(1):32-36

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Verification of a formula developed to predict the postoperative intraocular pressure after cataract surgery in primary angle-closure glaucoma

Journal of the Chinese Medical Association ◽

10.1016/j.jcma.2016.08.004 ◽

2016 ◽

Vol 79 (12) ◽

pp. 672-677 ◽

Cited By ~ 2

Author(s):

Yu-Fan Chang ◽

Yu-Chieh Ko ◽

Ling-Ing Lau ◽

Catherine Jui-Ling Liu

Keyword(s):

Intraocular Pressure ◽

Cataract Surgery ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Primary Angle Closure ◽

Primary Angle Closure Glaucoma

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Improvement of fluctuations of intraocular pressure after cataract surgery in primary angle closure glaucoma patients

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-014-2666-7 ◽

2014 ◽

Vol 252 (9) ◽

pp. 1463-1468 ◽

Cited By ~ 19

Author(s):

Naoki Tojo ◽

Mitsuya Otsuka ◽

Akio Miyakoshi ◽

Kazuya Fujita ◽

Atsushi Hayashi

Keyword(s):

Intraocular Pressure ◽

Cataract Surgery ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Primary Angle Closure ◽

Primary Angle Closure Glaucoma

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Angle closure glaucoma caused by delayed vitreous prolapse into the posterior chamber after phacoemulsification

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v16i1.335 ◽

2018 ◽

Vol 16 (1) ◽

pp. 19-22

Author(s):

Muralidhar Rajamani ◽

Chitra Ramamurthy

Keyword(s):

Intraocular Pressure ◽

Cataract Surgery ◽

Anterior Chamber ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Posterior Chamber ◽

Anterior Vitrectomy ◽

Good Outcome ◽

Vitreous Prolapse

Vitreous in the anterior chamber is a known cause of raised intraocular pressure following cataract surgery. We present a case of delayed intraocular pressure following cataract surgery in a patient with pseudoexfoliation caused by vitreous prolapse into the posterior chamber. Control of intraocular pressure was achieved by an anterior vitrectomy. Prompt recognition and management of this condition is essential for a good outcome.

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