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      The effect of phacoemulsification surgery on intraocular pressure and anterior segment anatomy of the patients with cataract and ocular hypertension

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          Abstract

          We evaluated the effect of phacoemulsification surgery on intraocular pressure (IOP), anterior chamber depth (ACD), iridocorneal angle (ICA), and central corneal thickness (CCT) of the patients with cataract and ocular hypertension. The decrease in IO P values of the 1 st week, 1 st month, 3 rd month, 6 th month, and 1 st year was statistically significant, but that of the 2 nd year was not significant. The increase in ACD and ICA values of the 1 st week, 1 st month, 3 rd month, 6 th month, and 1 st year was statistically significant, but that of the 2 nd year was not significant. The increase in CCT values of 1 st week and 1 st month was statistically significant, but those of 3 rd month, 6 th month, 1 st year, and 2 nd year were not significant. In conclusion, phacoemulsification surgery decreases IOP and increases ACD and ICA in the short-term. However, in the long-term it does not cause any significant changes.

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          Reduction in intraocular pressure after cataract extraction: the Ocular Hypertension Treatment Study.

          To determine the change in intraocular pressure (IOP) after cataract extraction in the observation group of the Ocular Hypertension Treatment Study. Comparative case series. Forty-two participants (63 eyes) who underwent cataract surgery in at least 1 eye during the study and a control group of 743 participants (743 eyes) who did not undergo cataract surgery. We defined the "split date" as the study visit date at which cataract surgery was reported in the cataract surgery group and a corresponding date in the control group. Preoperative IOP was defined as the mean IOP of up to 3 visits before the split date. Postoperative IOP was the mean IOP of up to 3 visits including the split date (0, 6, and 12 months' with "0 months" equaling the split date). In both groups, we censored data after initiation of ocular hypotensive medication or glaucoma surgery of any kind. Difference in preoperative and postoperative IOP. In the cataract group, postoperative IOP was significantly lower than the preoperative IOP (19.8 ± 3.2 mmHg vs. 23.9 ± 3.2 mmHg; P<0.001). The postoperative IOP remained lower than the preoperative IOP for at least 36 months. The average decrease in postoperative IOP from preoperative IOP was 16.5%, and 39.7% of eyes had postoperative IOP ≥ 20% below preoperative IOP. A greater reduction in postoperative IOP occurred in the eyes with the highest preoperative IOP. In the control group, the corresponding mean IOPs were 23.8 ± 3.6 before the split date and 23.4 ± 3.9 after the split date. Cataract surgery decreases IOP in patients with ocular hypertension over a long period of time. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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            The effect of cataract extraction on intraocular pressure.

            To review the current ophthalmic literature regarding the impact of modern cataract surgery on intraocular pressure (IOP). Many articles in the literature demonstrate a modest, long-lasting decrease in IOP following phacoemulsification and posterior chamber intraocular lens implantation in patients with primary open-angle glaucoma and ocular hypertension. The mechanism of this average pressure-lowering effect has yet to be elucidated. The IOP reductions obtained in patients with angle closure glaucoma are often more pronounced than those seen in patients with open angles. Patients with higher levels of preoperative IOP obtain greater average reductions in IOP, although this phenomenon may partially be explained by a statistical effect known as regression to the mean. Although it is well recognized that phacoemulsification may result in a modest sustained reduction in IOP, there are several limitations in the studies that have assessed the magnitude of this effect. The implications of such IOP reduction with cataract surgery on the medical and surgical algorithms for care in patients with open-angle glaucoma and coexistent cataract remain unclear. In contrast, the substantial benefits of cataract surgery in patients with acute and chronic angle-closure glaucoma have been well studied and are generally widely accepted. An improved understanding of the pathophysiological mechanisms of IOP lowering after cataract extraction may help us better predict which patients are most likely to benefit from simple cataract extraction, obviating the need for combined cataract and glaucoma surgical procedures in such circumstances.
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              Angle widening and alteration of ciliary process configuration after cataract surgery for primary angle closure.

              To evaluate quantitatively, by means of ultrasound biomicroscopy (UBM), changes in the anterior segment configuration, including the ciliary processes, induced by cataract surgery in eyes with primary angle closure. Retrospective interventional case series. Thirty-one eyes of 31 patients with primary angle closure or primary angle-closure glaucoma were treated with cataract surgery. Before cataract surgery, 10 eyes had been treated with laser peripheral iridotomy, and 1 with laser peripheral iridoplasty. Configuration of the anterior chamber was examined by means of UBM before and at 3 months after cataract surgery. Using UBM, anterior chamber depth (ACD), angle opening distance at points 500 mum from the scleral spur (AOD500), and trabecular-ciliary process distance (TCPD) were measured. Not only ACD and AOD500, but also TCPD, increased significantly after cataract surgery, compared with measurements obtained before surgery (P<0.001). Postoperative AOD500 was correlated significantly with postoperative TCPD (r = 0.72, P<0.001) and with the amount of change of TCPD caused by cataract surgery (Delta TCPD) (r = 0.52, P<0.01). Cataract surgery attenuated anterior positioning of the ciliary processes in eyes with primary angle closure, concomitant with significant widening of the angle. Cataract surgery resulted in not only complete dissolution of lens volume and pupillary block, but also attenuation of the anterior positioning of the ciliary processes, all of which contributed to postoperative widening of the angle in eyes with primary angle closure.
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                Author and article information

                Journal
                Indian J Ophthalmol
                Indian J Ophthalmol
                IJO
                Indian Journal of Ophthalmology
                Medknow Publications & Media Pvt Ltd (India )
                0301-4738
                1998-3689
                September 2015
                : 63
                : 9
                : 743-745
                Affiliations
                [1]Department of Ophthalmology, Ophthalmology Clinics, Turkish Red Crescent Hospital, Konya, Turkey
                [1 ]Department of Ophthalmology, Faculty of Medicine, Mevlana University, Konya, Turkey
                [2 ]Konya Eye Centre, Konya, Turkey
                [3 ]Department of Ophthalmology, Ataturk Training and Research Hospital, Ankara, Turkey
                [4 ]Department of Ophthalmology, Konya Training and Research Hospital, Konya, Turkey
                Author notes
                Correspondence to: Dr. Servet Cetinkaya, Ophthalmology Clinics, Turkish Red Crescent Hospital (Kizilay Hastanesi), Sukran Mh., Taskapu Medrese Sok. No: 15, Meram, 42200, Konya, Turkey. E-mail: drservet42@ 123456gmail.com
                Article
                IJO-63-743
                10.4103/0301-4738.171020
                4705715
                26632135
                bb1e0b1c-2c92-4473-ae8d-e883ac623726
                Copyright: © Indian Journal of Ophthalmology

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : 29 January 2015
                : 31 October 2015
                Categories
                Brief Communications

                Ophthalmology & Optometry
                cataract,intraocular pressure,ocular hypertension,phacoemulsification

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