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• W2014529379 abstract "Aim of study: To follow up prospectively the intraocular pressure (IOP) of healthy eyes with senile cataract undergoing phacoemulsification surgery over a duration of 4 years. Patients and methods: Thirty-five patients entering first eye cataract surgery had IOP measured by applanation tonometry pre-operatively and on day 1, at 1 month, 6 months, 1 year, 2 years and 4 years after surgery at 9 a.m. and again at 2 p.m. in the Department of Ophthalmology, Oulu University Hospital. Thirty-four patients attended the 1-year checkup, and the 2- and 4-year results are available for 31. Results: The pre-operative IOP was 16.0 (SD 4.3, range 6–25) mmHg in the morning and 16.4 (SD 4.0, range 8–25.5) mmHg in the afternoon. On the first postoperative day, the IOP was 2.1 ± 5.6 mmHg higher than before surgery (p = 0.029). At 1 month, the IOP morning measurement had decreased 2.8 ± 3.6 mmHg, and in the afternoon, the decrease was 3.0 ± 2.7 mmHg from the pre-operative level. At 6 months, the decrease was 3.3 ± 2.7 mmHg in the morning and 3.6 ± 2.7 mmHg in the afternoon, at 1 year, 3.2 ± 3.0 mmHg and 3.5 ± 3.2 mmHg, at 2 years, 3.2 ± 2.4 mmHg and 3.1 ± 2.8 mmHg, and at the 4-year postoperative checkup, 3.6 ± 3.4 mmHg and 3.6 ± 2.7 mmHg, respectively (p = 0.000 for all time-points). Conclusions: IOP decreases by about 3 mmHg (16–23% from the pre-operative IOP level) after phacoemulsification and remains at this reduced level with no trend towards an increase during 4 years. It has been reported that the values of intraocular pressure (IOP) are reduced between 1–5 mmHg after phacoemulsification compared to the situation before surgery (Peräsalo 1997; Tong & Miller 1998, Shingleton et al. 1999, Link et al. 2000; Mannes & Zeyen 2001). During the first 24 hr after the operation, an elevation of IOP is common, and those eyes with high pre-operative IOP values are more likely to have higher IOP spikes shortly after surgery (O`Brien et al. 2007), but 1 week later, the pressure is lower than before the operation (Pohjalainen et al. 2001). Patients with coexisting glaucoma manage with no or less medication after cataract surgery (Peräsalo 1997; Kim et al. 1999; Shingleton et al. 1999; Link et al. 2000; Pohjalainen et al. 2001; Mathalone et al. 2005). It has not been clear whether the decrease of IOP is permanent, and if not, how long the effect might endure. In some retrospective studies, the mean IOP reduction has been reported to be a mere 0.6–1.8 mmHg 2–3 years after surgery (Damji et al. 2006; Shingleton et al. 2006). The current prospective study of patients with senile cataract was designed to evaluate the IOP values for 4 years following phacoemulsification surgery. The patients who were asked to participate in the 4-year follow-up study on the effect of phacoemulsification surgery on IOP were on the waiting list for cataract surgery in the Department of Ophthalmology, Oulu University Hospital. The inclusion criteria were as follows: the patient (i) was going to have first eye surgery for senile cataract, (ii) had not undergone ocular surgery or laser treatment in either eye before, (iii) was not receiving eye drop medication except for artificial tears, (iv) had a pre-operative visual acuity of 0.1 (1.0 logMAR) or better, (v) was no older than 81 years of age, (vi) was able to attend the checkup visits independently and (vii) lived relatively close by (within 30 min reach) to the Oulu University Hospital. Systemic medications and diagnoses were allowed. A total of 43 patients were recruited for the study which began on February 2002. Thirty-five surgery eyes did not have pseudoexfoliation, whilst eight eyes were pseudoexfoliative. The eyes with pseudoexfoliation were removed from the study because they were so few in number. An informed consent was obtained from each of the participants. The study protocol included an eye examination pre-operatively, on the first postoperative day, and at 1 month, 6 months, 1 year, 2 years and 4 years after the operation. A double IOP measurement using the Goldmann applanation tonometer was taken in the morning (8–10 a.m.) and in the afternoon (1–3 p.m.) of each visit, except for the first postoperative day when only the morning measurement was taken. Age, sex, pre-operative blood pressure, heart rate, body mass index, axial length of the eye and the hardness of the lens at surgery as judged by the surgeon were recorded. The phacoemulsification surgeries were performed under topical anaesthesia through a clear corneal excision by seven surgeons from the Department of Ophthalmology, Oulu University Hospital, and an acrylic posterior chamber intraocular lens was implanted in all cases. There was one case with a posterior capsule rupture, and the lens was placed in the sulcus. All other surgeries were uneventful. The length of the surgery was 17 ± 10 SD (range 6–56) minutes. The patients did not receive antihypertensive medication on the day of surgery. Mean, standard deviation and range are given for IOP and age. Wilcoxon signed ranks test was used for studying the change of IOP. The Pearson correlation was used for examining possible correlations between age and several other parameters, with IOP change. spss Statistics® version 17.0 (SPSS Inc., Chicago, Illinois, USA) was used for statistical analyses. The participating patients (n = 35) were 59–81 years old (74 ± 5 years) at the beginning of the study. There were 13 men (age 72 ± 7 years) and 22 women (age 75 ± 4 years). There were 24 right eyes and 11 left eyes undergoing surgery. All eyes had an open anterior chamber angle. The best corrected pre-operative visual acuity of the operated eye was 1.0–0.1 logMAR (median 0.3). All 35 subjects attended the pre-operative, first postoperative day, 1 and 6 month postoperative examinations. Postoperative results at 1 year are available for 34 patients (one person withdrew from the study before). The 2-year postoperative results are available of 31 patients (two died and a total of two withdrew), and these 31 patients also completed the study at 4 years after their first eye cataract surgery. The final follow-up visit of the last patient took place in February 2009. None of the patients was using eye medication at the end of the study. The pre-operative IOP was 16.0 (SD 4.3, range 6–25) mmHg in the morning and 16.4 (SD 4.0, range 8–25.5) mmHg in the afternoon. On the first postoperative day, the IOP was 2.1 ± 5.6 mmHg higher than before surgery (p = 0.029). At 1 month, the IOP morning measurement had decreased 2.8 ± 3.6 mmHg, and in the afternoon, the decrease was 3.0 ± 2.7 mmHg from the pre-operative level. At 6 months, the decrease was 3.3 ± 2.7 mmHg in the morning and 3.6 ± 2.7 mmHg in the afternoon, at 1 year, 3.2 ± 3.0 mmHg and 3.5 ± 3.2 mmHg, at 2 years, 3.2 ± 2.4mmHg and 3.1 ± 2.8 mmHg, and at the 4-year postoperative checkup, 3.6 ± 3.4 mmHg and 3.6 ±2.7 mmHg, respectively (p = 0.000 for all time-points) (Table 1). The patients’ mean IOP in the morning did not differ significantly from that measured in the afternoon. The difference of the IOP measurements of the same day averaged −0.3–0.2 mmHg (SD varied between 1.4 and 2.5) during the different visits. The length of the surgery did not correlate with IOP or the change of IOP at any of the follow-up time-points. Furthermore, age, sex, pre-operative diastolic blood pressure, heart rate, body mass index, axial length of the eye or the hardness of the lens at surgery did not correlate with IOP values. Pre-operative systolic blood pressure correlated negatively with the IOP change reaching statistical significance at 1 day and in the afternoon of the 2-year visit (p = 0.050 and p = 0.019, respectively), but not at other time-points. This prospective study indicates that IOP decreases by about 3 mmHg after phacoemulsification cataract surgery. The effect appears to last for 4 years, and even then there was no fading of the effect seen. The number of patients included was not very large, but all but four patients, 89%, attended all scheduled visits of the 4-year follow-up study. A moderate elevation of IOP on day 1, however, was present in our patients. The same has been reported in previous studies (Pohjalainen et al. 2001), and the rise is mainly attributed to obstruction of the trabecular meshwork by viscoelastic device, debris or inflammation (Rainer et al. 2000; O`Brien et al. 2007). The central corneal thickness has been measured to increase in the immediate postoperative period being 14% thicker at 1 hr and 6% thicker at day 1 after cataract surgery, returning in the pre-operative thickness at 1 week (Salvi et al. 2007). This may add up to the measured elevation of IOP in the early postoperative period. The pre-operative level of IOP was similar in the morning and in the afternoon. The extent of the decline in IOP postoperatively did not differ significantly between measurements at 9 a.m. and 2 p.m. The literature seems to be sparse of other reports on diurnal postoperative IOP change. The reduction in IOP following cataract surgery has been found to be positively related to pre-operative IOP, and inversely related to pre-operative anterior chamber depth (Cekic et al. 1998; Altan et al. 2004; Issa et al. 2005). Increase in the anterior chamber volume, depth and angle after phacoemulsification and intraocular lens implantation in normotensive eyes with open angles accompanied by a significant fall in IOP has been observed (Doganay et al. 2008; Uçakhan et al. 2009). Thus, the reason for the reduced IOP values following phacoemulsification seems to be at least partly attributed to the change in the anatomy of the anterior eye, so that the aqueous humour outflow may increase. Ocular hypertension is a major risk factor for glaucomatous changes, and managing IOP is currently the only proven effective treatment for glaucoma. One should not ignore any means of lowering IOP, and glaucoma patients have been reported to need less medication after cataract surgery. This study supports previous reports highlighting the benefits of phacoemulsification surgery for managing patients with IOP above the goal and with coexisting cataract (Peräsalo 1997). In the case of a nonglaucomatous eye, the expected reduction of IOP by some 3 mmHg or about 20% after cataract surgery is not essential, but there is no indication of harmful effects of the lower IOP either. A 20% decrease of IOP is comparable to the response achievable with a single pharmacological antihypertensive agent, and the effect of phacoemulsification on IOP appears to last for at least 4 years." @default.
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• W2014529379 title "A four-year prospective study on intraocular pressure in relation to phacoemulsification cataract surgery" @default.
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