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Editors Selection IGR 14-2

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Comment by Kuldev Singh on:

50418 Reduction in Intraocular Pressure after Cataract Extraction: The Ocular Hypertension Treatment Study, Mansberger SL; Gordon MO; Jampel H et al., Ophthalmology, 2012; 119: 1826-1831

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Mansberger et al. provide evidence in support of the long-held belief that modern cataract surgery should be considered an intraocular- pressure-lowering surgical procedure. In contrast to many prior reports on the subject which have predominantly been case series, this post-hoc analysis of a large randomized clinical trial benefited from untreated ocular hypertensive controls who did not undergo cataract surgery.

Mansberger et al. provide evidence in support of the long held belief that modern cataract surgery should be considered an intraocular pressure lowering surgical procedure

The 3-4 mmHg sustained IOP lowering for three years found in the group that underwent phacoemulsification was quite impressive. Cataract surgery alone will continue to be a viable option for patients with mild glaucoma in the near future.

Cataract surgery alone will continue to be a viable option for patients with mild glaucoma in the near future

For patients with severe glaucoma, combined phacoemulsification with trabeculectomy allows for the possibility of achieving the lower IOPs that may be required for such patients. The many patients with visually disabling cataract who fall in between these two extremes with regard to disease severity, are potential candidates for a host of new less 'invasive' glaucoma procedures that can be combined with cataract surgery. Many such procedures are not associated with blebs and thus avoid the well known complications that come with anterior chamber to subconjunctival filtration. It remains to be seen whether or not this recent data from the Ocular Hypertension Treatment Study will expand the use of cataract surgery as an IOP lowering procedure in glaucoma patients who have less severe visual disability than has been previously considered necessary to pursue cataract surgery. There is increasing evidence to consider such an approach. One additional advantage of modern phacoemulsification relative to prior extracapsular cataract techniques is that the former does not adversely impact the likelihood of success with subsequent trabeculectomy.

If the large worldwide backlog of visually disabling cataract could somehow be eliminated by increasing the number of phacoemulsification procedures performed in both developing and developed countries, this would undoubtedly have a profoundly positive impact on the global burden of glaucomatous disease

While cataract surgery is clearly not the most effective glaucoma surgical procedure in terms of IOP lowering, one can make the argument that from a public-health standpoint, there is currently no better surgical procedure for mild glaucoma than clear corneal temporal phacoemulsification, largely because of the low risk of complications associated with such surgery. If the large worldwide backlog of visually disabling cataract could somehow be eliminated by increasing the number of phacoemulsification procedures performed in both developing and developed countries, this would undou btedly have a profoundly positive impact on the global burden of glaucomatous disease.

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