According to researchers in France, most patients with controlled mild to moderate primary open-angle glaucoma (POAG) will not have a reduction in IOP after cataract surgery; some patients may even have an immediate or a long-term IOP increase. Surgery alone does not lead to a change in the number of glaucoma medications, they noted. The researchers recommend practitioners consider other options for patients with more severe types of the disease.

The study evaluated 40 POAG patients who underwent phacoemulsification and documented their IOP and the number of medications before and one year after cataract surgery. One year after post-op, IOP decreased by a mean of 1.15±3mm Hg and the number of glaucoma medications remained unchanged with a difference of just − 0.1±0.43.

The team found higher preoperative IOP was associated with a greater IOP decrease after one year of follow-up. One and seven days after cataract surgery, 12.9% and 4.2% of the eyes had IOP spikes greater than 30mm Hg, respectively. One year post-surgery, 75.7% of the POAG eyes maintained the same number of glaucoma medications while 17.1% had a decrease and 7.2% of the eyes required additional glaucoma medications.

The researchers concluded that practitioners should not expect a drop in IOP after stand-alone cataract surgery in their POAG patients. They recommend careful post-op monitoring because some patients may present with IOP spikes that require immediate treatment.

Majstruk L, Leray B, Bouillot A, et al. Long term effect of phacoemulsification on intraocular pressure in patients with medically controlled primary open-angle glaucoma. BMC Ophthalmol. July 12, 2019. [Epub ahead of print].