Phaco benefits on IOP even better

Instead of combined surgery, cataract extraction alone by phacoemulsification through a clear corneal incision with posterior chamber IOL implantation may be the most appropriate procedure for patients with controlled or modestly uncontrolled glaucoma as well as for patients with ocular hypertension or glaucoma suspects.

"It may be that a lot of adult glaucoma is 'phacomorphic', and perhaps the best therapy is to remove the crystalline lens," said Richard L. Lindstrom, MD, founder and attending surgeon, Minnesota Eye Consultants, Minneapolis, US.

Dr Lindstrom presented evidence that the lowering achieved in eyes presenting with higher levels of IOP is much greater than realized.

To investigate the effect of cataract surgery on IOP, he undertook retrospective analyses. Dr Lindstrom found that the amount of IOP reduction after cataract surgery was proportional to the presurgical IOP and quite significant in those at the higher end of the spectrum. He then conducted a literature review, in which eyes from previously reported papers were stratified based on their presurgical IOP. Consistent with his own retrospective analyses, the results showed that in eyes with higher IOP, average decreases of at least 8–10 mmHg were achieved.

Additional evidence of the benefit of phacoemulsification on elevated IOP derives from an analysis of conversion rates of ocular hypertension to glaucoma after cataract surgery. Dr Lindstrom reported that the outcomes of his patient series compared very favourably with data reported in the Ocular Hypertension Treatment Study.

"Perhaps as patients develop elevated IOP and we are getting ready to treat that finding, we should consider if they might have an indication for lens removal, including early cataract, significant refractive error, or dissatisfaction because of presbyopia, and offer these patients the option of our fantastic operation of phacoemulsification with a posterior chamber IOL," Dr Lindstrom concluded.