Reducing IOP: A comparative analysis

Phacoemulsification alone has been proven to lower IOP a clinically significant amount over a sustained period of time.¹ Cataract surgery also has the added benefit of being considered an extremely safe and effective procedure with limited risks and high quality of life value. With my patients presenting with coexisting pathologies, I am often able to lower their IOPs sufficiently with cataract surgery alone that a combined procedure is not necessary.

When low pressures are needed to prevent visual field loss in patients with moderate to severe glaucoma, trabeculectomy or tube shunts are optimum options. However, they have far more risks associated with them than with cataract surgery alone and studies have also shown that combining these procedures with cataract surgery has a high rate of failure.²

Cataract surgery alone

Transitioning from combined procedures to cataract surgery alone resulted from findings that showed significant reductions in IOP and medication burden were achievable with cataract surgery alone. In a retrospective review of 588 eyes that underwent phacoemulsification and IOL implantation, glaucomatous eyes with preoperative IOPs between 23 to 31 mmHg had a mean 4.8 mmHg reduction in pressure sustained for 10 years.¹ While this is good news, additional lowering of IOP could mean a patient is relieved of some medication burden. When planning the treatment of patients with coexistent pathologies, it is expedient to weigh the risk factors and complication rates against the potential overall reduction in pressure and determine what will be maximally beneficial to the patient in the long run.

There is a 90% satisfaction rate in quality of life issues with cataract surgery with a complication rate of less than 5% and very few potential sight threatening risks. In some patients, the greater risk associated with a combined procedure is necessary to take, because a greater pressure reduction is needed, but many patients do not need a drastic reduction in pressure and can benefit from cataract surgery alone.