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Cataract surgery and IOP: a systematic review of randomised controlled trials

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Abstract

Purpose

Cataract and glaucoma are two of the most common ocular comorbidities. Cataract surgery has been shown to influence intra-ocular pressure (IOP) in patients with glaucoma; nevertheless, the extent of this effect remains controversial, especially in patients with open-angle glaucoma (OAG). The aim of this review is to determine the real effect of cataract surgery on IOP change in patients with OAG, focusing on data retrieved from randomised controlled trials (RCTs).

Methods

A systematic review was performed, including six different RCTs that studied the net effect of cataract surgery on IOP. Eligibility criteria required a full washout from hypotensive therapy, allowing accurate measurement of unmedicated IOP, both before and after surgery.

Results

Included studies revealed a consistent reduction on IOP occurring after surgery, varying between 4.1 and 8.5 mmHg depending on the RCT. There was also a decrease in the number of glaucoma medications, with a mean reduction of 0.2–1.0 agents postoperatively. Evaluation of adverse outcomes of cataract surgery showed a very favourable safety profile.

Conclusion

Although the role of cataract surgery in the algorithm of glaucoma treatment remains to be established, this review highlights a consistent decrease on IOP following surgery and a reduced dependency on glaucoma medications. Potential downgrade in medication can thus be considered in well-controlled glaucoma patients after phacoemulsification.

PROSPERO registry: CRD42022343378.

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Author information

Authors and Affiliations

  1. Hospital Beatriz Ângelo, Ophthalmology Department, Av. Carlos Teixeira N 3, 2674-514, Loures, Portugal

    Margarida Brízido, Pedro Filipe Rodrigues & Ana C. Almeida

  2. Centro Hospitalar Universitário Lisboa Norte – Hospital de Santa Maria, Lisbon, Portugal

    Luís Abegão Pinto

  3. Faculdade de Medicina, Universidade de Lisboa, Ophthalmology Department, Lisbon, Portugal

    Luís Abegão Pinto

Authors
  1. Margarida Brízido
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  2. Pedro Filipe Rodrigues
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  3. Ana C. Almeida
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  4. Luís Abegão Pinto
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Correspondence to Margarida Brízido.

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Appendix

Appendix

Search strategy for PubMed

  1. #1.

    Cataract surgery OR cataract extraction OR phacoemulsification OR Lens extraction OR “Phacoemulsification”[MeSH].

  2. #2.

    Open-angle glaucoma OR open angle glaucoma OR (OAG OR POAG) OR “Glaucoma, Open-Angle”[MeSH].

  3. #3.

    Intra-ocular pressure OR intra ocular pressure OR intraocular pressure OR IOP OR “Intraocular Pressure”[MeSH].

  4. #4.

    Washout OR “Medication washout” OR unmedicated IOP OR unmedicated diurnal IOP.

  5. #5.

    Randomised controlled trial OR randomised clinical trial OR randomized controlled trial OR randomized clinical trial OR RCT OR Randomized Controlled study OR Randomized Clinical Study OR Randomised Controlled Study OR Randomised Clinical study OR Randomized Controlled Trial[Publication Type].

Final search:

#1 AND #2 AND #3 AND #4 AND #5

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Brízido, M., Rodrigues, P.F., Almeida, A.C. et al. Cataract surgery and IOP: a systematic review of randomised controlled trials. Graefes Arch Clin Exp Ophthalmol 261, 1257–1266 (2023). https://doi.org/10.1007/s00417-022-05911-3

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  • DOI: https://doi.org/10.1007/s00417-022-05911-3

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