1. IMPACT OF CATARACT SURGERY UPON INTRAOCULAR PRESURE CONTROL IN GLAUCOMA PATIENTS Crenguta Feraru, Anca Pantalon “Gr.T. Popa” University of Medicine and Pharmacy Iasi, Romania “St. Spiridon” University Hospital, Ophthalmology Department, Iasi, Romania
Work hypothesis:
Cataract extraction reduces IOP in glaucoma patients, increases VA, diminishes the number of topical medication and increases QoL.
AIM OF STUDY: impact of cataract surgery on IOP level in glaucoma patients
MATERIAL AND METHOD:
retrospective study in glaucoma patients undergoing conventional cataract surgery
data collection: preoperatory - demographic data (age, sex), glaucoma type, BCVA (decimal), IOP, C/D ratio;
intraoperatory/ postoperatory – type of complications
postoperatory – BCVA, IOP and number of glaucoma medications after 24h, 2 weeks, 4 weeks and 4 months after surgery
statistical analysis – SPSS® 18.0
RESULTS:
69 eyes from 63 patients
mean age = ± 8.62 years (range = years)
sex ratio: F:M = 1:2
BCVA preop = 0.18 ± 0.21 (range = light perception– 0.9)
mean C/D ratio = 0.75 ± 0.24 (0.1 – 1);
63% eyes with C/D ratio ≥0.8
conventional surgical procedure: faco + PC IOL
- 1 case with EEC +PC IOL
duration of hospitalization = 4± 1.9 days (2-13 days)
intraop complications: IFIS (2 eyes); synechiolysis (2 eyes)
Glaucoma categories in the study
Nr. of glaucoma medications
OHT & other glaucomas
PCAG
POAG
SOAG
Change in number of topical glaucoma medications before/ after cataract surgery
BCVA dynamics during the study
IOP variations during the study
IOP (preop) IOP (24h) IOP (at release) IOP (2 weeks) IOP (2 weeks) IOP (4 months)
Nr medic (preop) Nr. medic (at release) Nr. medic (2 weeks) Nr. medic (6 weeks)
BCVA (preop) BCVA (at release) BCVA (2 weeks) BCVA (6 weeks) BCVA (4 months)
CAG - IOP variations
during the study
OAG - IOP variations
during the study
POAG - IOP variations
during the study
% patients with/ without medication
% patients with medication
% patients without medication
IOP (preop) IOP (24h) IOP (release) IOP (2 weeks) IOP (6 weeks)
IOP (preop) IOP (24h) IOP (release) IOP (2 weeks) IOP (6 weeks)
IOP (preop) IOP (24h) IOP (release) IOP (2 weeks) IOP (6 weeks)
% preop % at release % at 2 weeks % at 6 weeks
POAG – Nr. of medic. changes
during the study
OAG – Nr. of medic. changes
during the study
CAG – Nr. of medic. changes
during the study
Nr. medic (preop) Nr. medic (release) Nr. medic (2 weeks ) Nr. medic (6 weeks)
Nr. medic (preop) Nr. medic (release) Nr. medic (2 weeks ) Nr. medic (6 weeks)
Nr. medic (preop) Nr. medic (release) Nr. medic (2 weeks ) Nr. medic (6 weeks)
CONCLUSIONS
1. Cataract surgery mildly reduces the IOP in glaucoma patients, but it significantly increases the BCVA.
2. In our study we proved that after cataract surgery there was a significant reduction in the number of topical medication used to lower the IOP in glaucoma patients (10% patients needed no additional glaucoma treatment)
3. The most important effect on IOP after cataract surgery was noted in cases with open angle glaucoma (OAG - pseudoexfoliative glaucoma) and closed angle glaucoma (CAG).
4. No major surgical related complications were present in these study, therefore no influence on the IOP could be attributed.
5. 24h postop, the IOP spikes were more prominent in PEX glaucoma compared to other forms of glaucoma; these IOP variation usually counts as an additional risk factor for optic nerve damage in glaucoma patients, therefore careful monitoring should be done early postoperatively in these patients.