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Effect of Cataract Surgery on Intraocular Pressure Lowering
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE OF REVIEW
To review the literature evaluating the effect of cataract surgery on intraocular pressure (IOP) in patients with glaucoma.
RECENT FINDINGS
Recent high-quality secondary analyses of large and primary trials continue to show IOP lowering following cataract surgery. Likewise, cataract surgery remains a key treatment for angle closure glaucoma. Some micro-invasive glaucoma surgeries (MIGS) have strong evidence to be performed at the time of cataract surgery. Data clarifying when these surgeries should be combined with cataract surgery is emerging. The mechanism underlying IOP lowering after cataract surgery remains unclear.
SUMMARY
Patients who are glaucoma suspects with visually significant cataracts would benefit from cataract surgery alone. Those with mild-moderate damage on 1-2 classes of medications would most likely benefit from additional MIGS. Patients with advanced disease would benefit from cataract surgery and a choice of additional surgery, which depends on disease status and patient factors. Clear lens extraction is becoming a more accepted practice as a primary procedure for patients with angle closure and high IOP or glaucoma. The role of additional MIGS in angle closure needs further study.
Additional Info
Disclosure statements are available on the authors' profiles:
How much does cataract surgery contribute to intraocular pressure lowering?
Curr Opin Ophthalmol 2024 Mar 01;35(2)147-154, J Sabharwal, AK Garg, PY RamuluFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Practitioners who see patients with cataracts presenting with increased intraocular pressure, glaucoma, or, in particular, narrow angles will typically engage in a conversation regarding the benefits of cataract surgery, or clear lens extraction, and its impact on intraocular pressure. This literature review will help support a conversation about surgical choices with patients who have cataracts and either open or closed angles, especially those with glaucoma, with respect to intraocular pressure. The authors nicely summarized the literature in their key points. Intuitively, although further research needs to be conducted to understand the underlying mechanism, a reduction in aqueous production could benefit patients in general and/or in addition to cataract surgery.
Other findings noted were that patients who have ocular hypertension and have not started on topical treatment could have "a significantly lower need for glaucoma treatment after cataract surgery" and that, although cataract surgery alone can result in reduced intraocular pressure, additional micro-invasive glaucoma surgery can improve treatment outcomes "in patients with mild to moderate disease on one to two drop therapies." Finally, even for patients without a cataract, there is a role for clear lens extraction for those with (potential) angle closure, elevated intraocular pressure, or glaucoma.