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Editors Selection IGR 9-2

Surgical Therapy: IOP after phacoemulsification in normals

Comment by Don Budenz on:

26261 Changes in intraocular pressure and anterior segment morphometry after uneventful phacoemulsification cataract surgery, Dooley I; Charalampidou S; Malik A et al., Eye, Apr; 4: 519-526

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This is a prospective observational study in which Daaley et al. (986) measure intraocular pressure (IOP) and anterior chamber parameters before and six weeks after uncomplicated phacoemulsification with intraocular lens implantation in non-glaucomatous subjects. The study found that IOP decreased an average of 2.5 mmHg in this group of patients, over 50% of whom were hypermetropic. Corrections in IOP for central corneal thickness using the Ehlers formula yielded even more IOP reduction after cataract surgery, a mean reduction of 3.8 mmHg (misquoted in the abstract as 3.2 mmHg). Multiple anterior chamber depth parameters, measured with a Scheimpflug camera (Pentacam), showed that the chamber deepened after cataract surgery. These parameters included anterior chamber depth, anterior chamber volume, and anterior chamber angle. The main result of the study is that preoperative IOP and several anterior chamber depth parameters are predictive of IOP reduction after cataract surgery. The authors suggest that one can use these parameters in decision-making when planning surgical intervention in glaucoma patients. They acknowledge that further studies need to be performed to generalize their results to ocular hypertensive or glaucoma patients. The study is scientifically and statistically sound. The findings agree with prior studies of this type and there is biological plausibility to the conclusion that anterior chamber depth increases and IOP decreases after cataract surgery. Unique to this analysis is that the relationships between anterior chamber depth and IOP reduction persists even when IOP is adjusted for central corneal thickness. I am not sure how clinically important this is, since the central corneal thickness does not change six weeks after cataract surgery in this or other studies and most ophthalmologists are not correcting for central corneal thickness in the management of glaucoma patients.

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