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Postoperative intraocular pressure profile following cataract surgery in patients with cataract and occludable angles

Poster Details

First Author: K.Aditya INDIA

Co Author(s):    M. Singh   V. Gupta   N. Singh   S. Kokhar           

Abstract Details

Purpose:

In Indian subcontinent and asia pacific region ,Angle closure glaucoma is leading cause of Ocular morbidity.Effect of Catactogenesis on pathophysiology of Angle Closure is being increasingly established. Relative Lens Position(RLP) is a sensitive indicator for Anterior Chamber Crowding owing to forward shift of iris lens diaphragm and relative pupillary block.Thus in high risk patients of occludable angle i.e Posterior Trabecular Meshwork not visible in >270 degree, effect of cataract extraction on IOP reduction needs to be established to establish guidelines for lens extraction as preventive strategy for progression of Angle Closure.

Setting:

This study was conducted at Dr Baba Saheb Ambedkar Hospital ,New Delhi, a tertiary care center situated in urban area catering to both urban and rural population.

Methods:

This Randomised Prospective Interventional Comparative Study was conducted from June 2014 to January 2015 on 50 diagnosed cases of Immature Senile Cataract NS II or more advanced with goniocopically occludable angles i.e 270 degree of Posterior Trabecular Meshwork not visible. Preoperative Intraoular pressure was determined by Applanation Tonometry and Biometric measurements i.e Axial length,Central Anterior Chamber Depth,Lens thickness with PacScan300AP A scan. Postoperative final IOP measurement was taken at day 90 apart from day 1,7,14,28 by Applanation Tonometry.

Results:

Mean Preop IOP was 16.98+/-1.96. Day1 Postop mean IOP was 18.54+/-2.06(p<0.001) Day 7 Postop mean IOP was 16.94 +/-1.9(p=0.492) Day 14 Postop mean IOP was 15.58+/-1.94(p<0.001) Day 28 Postop mean IOP was 14.68+/-1.92(p<0.001) Day 90 Post op mean IOP was 13.88+/-2.11.(p<0.001) Mean IOP drop was3.1+/-0.79 mm Hg.(p<0.001

Conclusions:

We conclude that in patients with high risk of angle closure, anterior segment crowding plays a major role. Removal of crystalline lens restores deep Anterior Chamber Configuration with increased AC volume with improved drainage facility dur to relief of relative pupillary block,hence leading to decreament of Intraocular Pressure. Initial transient rise could be due to Ocular viscoelastic devices used peroperatively which may still be underestimated due to accompanying corneal edema. IOP comes back to baslline by day 7,continues to dip and plateaus by day day 90. Role of ultrasonic energy in Trabecular meshwork metalloproteinaes activation is also hypothesised.

Financial Disclosure:

NONE

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