Phaco appears to have minimal long-term effect on IOP in patients with open-angle glaucoma

This retrospective study found that uncomplicated phacoemulsification had no significant IOP-lowering effect compared with phakic fellow eyes for up to three years postoperatively in patients with ocular hypertension or open-angle glaucoma. There was also no difference between the mean number of postoperative IOP-lowering medications used in surgical and fellow eyes.

To the authors’ knowledge this is the first study examining the effect of phacoemulsification on IOP using fellow eyes as untreated controls. They reviewed the charts of 29 patients with open-angle glaucoma or ocular hypertension who had unilateral phacoemulsification with the other eye remaining phakic for at least three years postoperatively. To avoid regression to the mean, the study incorporated stringent inclusion and exclusion criteria, including multiple preoperative measurements.

There was no statistically significant difference in IOP between surgical eyes and fellow eyes before or at any time after surgery, nor was there a difference in the mean number of IOP-lowering medications before or after surgery.

The authors conclude that if confirmed prospectively with a larger cohort study powered to detect small IOP differences between eyes, this finding may support the drive to develop effective minimally invasive pressure-lowering procedures to be performed concurrently with phacoemulsification that have a better safety profile than combined phacoemulsification–trabeculectomy. Furthermore, this may prompt continued investigation regarding the short- and long-term effect of phacoemulsification on anterior chamber configuration in order to identify more precisely those patients in whom phacoemulsification may improve IOP control.