Intraocular Pressure After Phacoemulsification in Open-angle Glaucoma Patients With Uncontrolled or Marginally...

To evaluate intraocular pressure (IOP) after phacoemulsification in open-angle glaucoma (OAG) patients with uncontrolled or marginally controlled glaucoma and/or severe visual field (VF) loss.

Retrospective case series of OAG patients without prior glaucoma surgery undergoing phacoemulsification. Uncontrolled or marginally controlled glaucoma was defined as IOP>21 mm Hg despite maximally tolerated medications or requiring >3 topical drugs for IOP control. Severe VF loss was defined as VF mean deviation ≤-12 dB. Eyes with postoperative IOP elevation were identified using 4 different definitions.

Of 56 eyes (56 patients), 10 eyes (17.8%) had IOP elevation ≥10 mm Hg at postoperative day 1. At 1 year (N=45), the average preoperative IOP of 14.3±3.5 mm Hg decreased to 13.8±3.6 mm Hg (P=0.312), and number of medications of 3.2±1.1 decreased to 2.8±1.2 (P=0.165). Eleven eyes (24.4%) had increase in IOP of ≥3 mm Hg, whereas 14 eyes (31.1%) had decrease of ≥3 mm Hg. Nine eyes (20.0%) had higher IOP without medication changes and 9 eyes (20.0%) required additional medications or surgery for IOP control; 3 eyes (6.7%) required trabeculectomy. Higher IOP at 1 year was associated with IOP elevation ≥10 mm Hg at postoperative week 1 (P=0.020).

Phacoemulsification resulted in nonsignificant 1-year IOP change in OAG patients with uncontrolled or marginally controlled glaucoma and/or with severe VF loss. Although 40% of eyes had higher IOP after phacoemulsification at 1-year postoperatively, only 6.7% required trabeculectomy.