The effect upon IOP anterior chamber depth and angle widening of cataract surgery in glaucomatous and non-glaucomatous patients with preoperative shallow anterior chamber

Session Details

Session Title: Glaucoma I

Session Date/Time: Monday 07/09/2015 | 08:00-10:30

Paper Time: 08:28

Venue: Room 10

First Author: : M.Constantin ROMANIA

Co Author(s): :    O. Moraru   I. Iliescu                 

Abstract Details

Purpose:

Shallow anterior chamber (AC) has an impact on the intraocular pressure (IOP) in normal patients but especially in glaucomatous patients. Clear lens extraction/ cataract surgery can be the best choice in patients with small depth AC where the IOP control poses a challenge. Our paper evaluates the impact on the IOP, the AC depth and angle of removing the lens in eyes with cataract, with or without concurrent glaucoma. We study the effect of cataract surgery on one month postoperative IOP, taking into consideration each of the following preoperative parameters: AC depth (ACD), angle (ACA), lens thickness (LT) and IOP.

Setting:

Oculus Eye Clinic- Bucharest, Romania

Methods:

203 eyes (135 patients) with ACD lower than 2.9 mm operated for cataract (6 month period) and with one month follow-up were included in the study. The preoperative diagnostic was used to divide the eyes into 3 groups: non- glaucomatous (N), primary open angle (POAG) and angle closure (ACG) glaucoma patients. For all eyes we measured the preoperative ACD, ACA, IOP and also the preoperative LT. Postoperatively we evaluated the change in ACD, ACA and IOP, the amount of IOP reduction influenced by the preoperative ACD, ACA, LT and IOP and the postoperative ACD and ACA change versus LT.

Results:

The preoperative mean central ACD was 2.64, mean ACA (temporal quadrant) - 18.29 degrees, mean IOP 16.79 (SD 4.31) The postoperative mean ACD and ACA increased significantly (3.74 ± 0.37mm; 34.79 ± 4.51 degrees); mean postoperative IOP- 12.09 (SD 3.1). The mean IOP reduction was statistically significant over all 3 groups. The IOP change was the highest in the ACG group followed by the POAG group and the N group. IOP change after surgery shows no significant relation with LT but is significantly correlated with changes in ACD and ACA.

Conclusions:

Cataract surgery plays an important role in lowering the IOP in patients with ACG and POAG. Lens extraction should be considered as a valuable glaucoma therapy option, with the intent of targeting better postoperative IOP control, sometimes with less topical glaucoma treatment. Cataract extraction also correlates with deepening of the central ACD and widening of the ACA. It is well known that as LT increases there is a predisposition to relative pupillary block and ACA decrease. Therefore cataract extraction can be considered as an early step in therapy in eyes with glaucoma.

Financial Interest:

NONE