Cataract surgery lowers IOP, medication use

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August 31, 2021

2 min read

Disclosures:
Mansberger reports receiving financial support from Thea, Allergan/AbbVie and Nicox. Please see the study for all other authors’ relevant financial disclosures.


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Patients with ocular hypertension may benefit from cataract surgery, according to findings published in the American Journal of Ophthalmology.

“Studies suggest that cataract surgery lowers IOP, and that this reduction is generally proportional to presurgical IOP. As well, several papers report a decrease in ocular hypotensive medications with cataract surgery,” Steven L. Mansberger, MD, MPH, ophthalmologist at Legacy Health in Portland, Ore., and colleagues wrote. “While these reports are helpful, they rarely examine the change in both IOP and ocular hypotensive medications, nor the changes over a long period of time.”

In a secondary analysis of results from a randomized clinical trial, Mansberger and colleagues analyzed data from 623 participants aged 40 to 80 years from the Ocular Hypertension Treatment Study (OHTS) Medication Group. Of these participants, 92 (n = 149 eyes) underwent cataract surgery in at least one eye during the study, while the remaining 531 (n = 1,004 eyes) did not. All participants had IOP between 24 mm Hg and 32 mm Hg in one eye and between 21 mm Hg and 32 mm Hg in the other, no glaucomatous structural or functional damage at enrollment, and best-corrected visual acuity of at least 20/40 in both eyes.

Researchers compared data from the cataract surgery group after their first postoperative visit with the control group’s corresponding 15th visit. Because the OHTS does not specify the date of this visit, Mansberger and colleagues refer to the visit as the “split date.” The primary outcome was the difference in preoperative and postoperative IOP and the number of classes of ocular hypotensive medications between the cataract and control group over a 72-month period.

Researchers found that cataract surgery decreased the number of ocular hypotensive medications (mean –0.4 medications; P < .005) compared with the control group. At the defined split date, 23% of eyes were free of medication, and 41% of eyes had reduced medication. While the cataract surgery group experienced a decrease in IOP (P < .001), the difference in IOP between them and the control group decreased over time and became non-significant after 12 months.

“This study showed that cataract surgery produced a lowering of IOP for about 1 year after surgery in the medication group of the OHTS and decreased medication burden for a prolonged period. Glaucoma conversion or incidence of primary open angle glaucoma decreased after cataract surgery when considering optic disc as an endpoint, but not for visual field, nor when combining either visual field or optic disc endpoints,” Mansberger and colleagues wrote. “Together, these data suggest modest benefits of cataract surgery (beyond the visual improvement resulting from cataract surgery) in reducing IOP and medication burden when a study-specified target IOP was used.”

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Kathy Laura

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