See also comment(s) by Richard Lee •
Purpose: To review studies and magnetic resonance imaging findings that show why phacoemulsification with artificial lens implantation (phaco/IOL) surgery is a technique that significantly lowers elevated intraocular pressure (IOP) in eyes with ocular hypertension and adult glaucoma. Setting: Phillips Eye Institute, Minneapolis, Minn, and private practice, Savannah, Ga. Methods: The IOP of 588 nonglaucoma and 124 glaucoma eyes operated with phaco/IOL was retrospectively reviewed at surgery, 1 year after surgery, and at the final chart recording. Eyes were stratified and divided into 5 groups based on IOP at surgery. The IOP changes 1 year after surgery and at final check, as well as effects of patient's age at surgery and years of postoperative follow-up, were evaluated. Results: The nonglaucoma group's mean IOP reduction was 6.5 mm Hg (27%) in the 31- to 23-mm Hg presurgical group, 4.8 mm Hg (22%) in the 22- to 20-mm Hg group, 2.5 mm Hg (14%) in the 19- to 18-mm Hg group, 1.6 mm Hg (9%) in the 17- to 15-mm Hg group, and 0.2 mm Hg (0.1%) higher in the 14- to 9-mm Hg group. The glaucoma group's mean IOP reduction was 8.5 mm Hg (34%) in the 29- to 23-mm Hg presurgical group, 4.6 mm Hg (22%) in the 22- to 20-mm Hg group, 3.4 mm Hg (18%) in the 19- to 18-mm Hg group, 1.1 mm Hg (10%) in the 17- to 15-mm Hg group, and increased 1.7 mm Hg (15%) in the 14- to 5-mm Hg group. Conclusions: The IOP reduction of nonglaucomatous and glaucomatous eyes was similar. Greater IOP reduction was found than previously reported. The IOP reduction was proportional to presurgical IOP. The higher the presurgical IOP, the greater was the IOP reduction. One year IOP reductions were sustained for 10 years and were similar for patients of all ages. These studies and magnetic resonance imaging findings support the proposition that the crystalline lens, as it enlarges with age, may be a major cause of ocular hypertension and adult glaucoma, and that phaco/IOL surgery may help prevent and treat adult glaucoma.
B. J. Poley. 4728 Wilford Way, Edina, MN 55435, United States. firstname.lastname@example.org
12.14.3 Phacoemulsification (Part of: 12 Surgical treatment > 12.14 Combined cataract extraction and glaucoma surgery)