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Editors Selection IGR 19-4

Surgical treatment: IOP reduction in pseudophakia

Comment by Tin Aung & Monisha Nongpiur on:

67446 Lens Position Parameters as Predictors of Intraocular Pressure Reduction After Cataract Surgery in Glaucomatous Versus Nonglaucomatous Eyes, Coh P; Moghimi S; Chen RI et al., Investigative Ophthalmology and Visual Science, 2016; 57: 2593-2599

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Cataract extraction has been shown to be effective in reducing intraocular pressure (IOP); however, the responses are variable and the exact mechanisms involved in IOP lowering are not fully understood. Some of the predictors of IOP reduction after cataract surgery include higher level of pre-operative IOP, shallower anterior chambers, narrower angles and smaller anterior vault.

The study suggests that lens position, an easily computed parameter, may be utilized to predict IOP response to cataract surgery

In this paper, Coh and colleagues evaluated the relationship between lens parameters and IOP reduction following cataract surgery in non-glaucomatous and eyes with primary open-angle glaucoma (POAG). Cataract surgery resulted in 15.8% IOP lowering in the control group and 16.9% in the POAG group. Pre-operative IOP was a significant predictor of IOP reduction in both the groups while lens position (LP, defined as the sum of anterior chamber depth (ACD) and one-half lens thickness (LT)) was a significant predictor only in the non-glaucomatous group. The study suggests that LP, an easily computed parameter may be utilized to predict IOP response to cataract surgery.

However, this may be contentious as the association with LP was significant in the non-glaucomatous eyes group only. Moreover, LP, computed from two axial parameters, estimates the position of the center of the lens from the cornea, and not with respect to the anterior chamber angles (unlike lens vault).

One of the limitations of the study was the inclusion of pre-operative IOP as a variable when assessing the predictors of percentage IOP reduction, as pre-operative IOP is used in the computation of percentage IOP change. It was also not clear how the authors performed the multivariate analyses since the factors significant in the univariate analysis were not adjusted for.

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