The effect of combined phacoemulsification and endo-cyclophotocoagulation on intraocular pressure fluctuation assessed by the water drinking test in patients with primary open angle glaucoma

Introduction: The aim of this study was to assess the effect of phacoemulsification and endo-cyclophotocoagulation (phaco-ECP) on intraocular pressure (IOP) fluctuation as assessed by the water drinking test (WDT) in primary open angle glaucoma (POAG). Methods: This was a prospective observatio...

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Main Authors: Mohammad Razali, Amirah, Tang, Seng Fai, Syed Zakaria, Syed Zulkifli, Che-Hamzah, Jemaima, Aung, Tin, Othman, Othmaliza, Md Din, Norshamsiah
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出版: Karger Publishers 2023
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spelling oai:psasir.upm.edu.my:108996 http://psasir.upm.edu.my/id/eprint/108996/ The effect of combined phacoemulsification and endo-cyclophotocoagulation on intraocular pressure fluctuation assessed by the water drinking test in patients with primary open angle glaucoma Mohammad Razali, Amirah Tang, Seng Fai Syed Zakaria, Syed Zulkifli Che-Hamzah, Jemaima Aung, Tin Othman, Othmaliza Md Din, Norshamsiah Introduction: The aim of this study was to assess the effect of phacoemulsification and endo-cyclophotocoagulation (phaco-ECP) on intraocular pressure (IOP) fluctuation as assessed by the water drinking test (WDT) in primary open angle glaucoma (POAG). Methods: This was a prospective observational study carried out at a tertiary referral centre. POAG patients on topical antiglaucoma medications and planned for phaco-ECP were recruited. WDT was performed before surgery and 6 weeks postoperatively by drinking 10 mL/kg of water in 5 min followed by serial IOP by Goldmann applanation tonometry measurements at 15, 30, 45, and 60 min. Mean IOP, IOP fluctuation (difference between highest and lowest IOP), IOP reduction, and factors affecting IOP fluctuation were analysed. Results: Twenty eyes from 17 patients were included. Baseline IOP was similar before (14.7 ± 2.7 mm Hg) and after (14.8 ± 3.4 mm Hg, p = 0.90) surgery. There was no difference in mean IOP (17.6 ± 3.4 mm Hg vs. 19.3 ± 4.7 mm Hg pre- and postoperative, respectively, p = 0.26) or peak IOP (19.37 ± 3.74 mm Hg vs. 21.23 ± 5.29 mm Hg, p = 0.25), albeit a significant reduction in IOP-lowering medications (2.2 ± 1.15 vs. 0.35 ± 0.93, p < 0.001) postoperatively. IOP fluctuation was significantly greater (6.4 ± 3.2 mm Hg vs. 4.6 ± 2.1 mm Hg, p = 0.015) with more eyes having significant IOP fluctuation of ≥6 mm Hg (11 eyes [55%] vs. 4 eyes [20%], p < 0.001) postoperatively. Factors that were significantly associated with increased postoperative IOP fluctuations were higher preoperative IOP fluctuation (β = 0.69, 95% CI 0.379–1.582, p = 0.004) and more number of postoperative antiglaucoma medications (β = 0.627, 95% CI 0.614–3.322, p = 0.008). Conclusion: Reducing aqueous production with phaco-ECP does not eliminate IOP fluctuation in POAG patients. The increase in postoperative IOP fluctuation suggests increased outflow resistance after phaco-ECP. Karger Publishers 2023-03-14 Article PeerReviewed Mohammad Razali, Amirah and Tang, Seng Fai and Syed Zakaria, Syed Zulkifli and Che-Hamzah, Jemaima and Aung, Tin and Othman, Othmaliza and Md Din, Norshamsiah (2023) The effect of combined phacoemulsification and endo-cyclophotocoagulation on intraocular pressure fluctuation assessed by the water drinking test in patients with primary open angle glaucoma. Ophthalmic Research, 66 (1). pp. 854-861. ISSN 0030-3747; ESSN: 1423-0259 https://karger.com/ore/article/66/1/854/836829/The-Effect-of-Combined-Phacoemulsification-and 10.1159/000530072
institution UPM IR
collection UPM IR
description Introduction: The aim of this study was to assess the effect of phacoemulsification and endo-cyclophotocoagulation (phaco-ECP) on intraocular pressure (IOP) fluctuation as assessed by the water drinking test (WDT) in primary open angle glaucoma (POAG). Methods: This was a prospective observational study carried out at a tertiary referral centre. POAG patients on topical antiglaucoma medications and planned for phaco-ECP were recruited. WDT was performed before surgery and 6 weeks postoperatively by drinking 10 mL/kg of water in 5 min followed by serial IOP by Goldmann applanation tonometry measurements at 15, 30, 45, and 60 min. Mean IOP, IOP fluctuation (difference between highest and lowest IOP), IOP reduction, and factors affecting IOP fluctuation were analysed. Results: Twenty eyes from 17 patients were included. Baseline IOP was similar before (14.7 ± 2.7 mm Hg) and after (14.8 ± 3.4 mm Hg, p = 0.90) surgery. There was no difference in mean IOP (17.6 ± 3.4 mm Hg vs. 19.3 ± 4.7 mm Hg pre- and postoperative, respectively, p = 0.26) or peak IOP (19.37 ± 3.74 mm Hg vs. 21.23 ± 5.29 mm Hg, p = 0.25), albeit a significant reduction in IOP-lowering medications (2.2 ± 1.15 vs. 0.35 ± 0.93, p < 0.001) postoperatively. IOP fluctuation was significantly greater (6.4 ± 3.2 mm Hg vs. 4.6 ± 2.1 mm Hg, p = 0.015) with more eyes having significant IOP fluctuation of ≥6 mm Hg (11 eyes [55%] vs. 4 eyes [20%], p < 0.001) postoperatively. Factors that were significantly associated with increased postoperative IOP fluctuations were higher preoperative IOP fluctuation (β = 0.69, 95% CI 0.379–1.582, p = 0.004) and more number of postoperative antiglaucoma medications (β = 0.627, 95% CI 0.614–3.322, p = 0.008). Conclusion: Reducing aqueous production with phaco-ECP does not eliminate IOP fluctuation in POAG patients. The increase in postoperative IOP fluctuation suggests increased outflow resistance after phaco-ECP.
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author Mohammad Razali, Amirah
Tang, Seng Fai
Syed Zakaria, Syed Zulkifli
Che-Hamzah, Jemaima
Aung, Tin
Othman, Othmaliza
Md Din, Norshamsiah
spellingShingle Mohammad Razali, Amirah
Tang, Seng Fai
Syed Zakaria, Syed Zulkifli
Che-Hamzah, Jemaima
Aung, Tin
Othman, Othmaliza
Md Din, Norshamsiah
The effect of combined phacoemulsification and endo-cyclophotocoagulation on intraocular pressure fluctuation assessed by the water drinking test in patients with primary open angle glaucoma
author_facet Mohammad Razali, Amirah
Tang, Seng Fai
Syed Zakaria, Syed Zulkifli
Che-Hamzah, Jemaima
Aung, Tin
Othman, Othmaliza
Md Din, Norshamsiah
author_sort Mohammad Razali, Amirah
title The effect of combined phacoemulsification and endo-cyclophotocoagulation on intraocular pressure fluctuation assessed by the water drinking test in patients with primary open angle glaucoma
title_short The effect of combined phacoemulsification and endo-cyclophotocoagulation on intraocular pressure fluctuation assessed by the water drinking test in patients with primary open angle glaucoma
title_full The effect of combined phacoemulsification and endo-cyclophotocoagulation on intraocular pressure fluctuation assessed by the water drinking test in patients with primary open angle glaucoma
title_fullStr The effect of combined phacoemulsification and endo-cyclophotocoagulation on intraocular pressure fluctuation assessed by the water drinking test in patients with primary open angle glaucoma
title_full_unstemmed The effect of combined phacoemulsification and endo-cyclophotocoagulation on intraocular pressure fluctuation assessed by the water drinking test in patients with primary open angle glaucoma
title_sort effect of combined phacoemulsification and endo-cyclophotocoagulation on intraocular pressure fluctuation assessed by the water drinking test in patients with primary open angle glaucoma
publisher Karger Publishers
publishDate 2023
_version_ 1819301842745556992
score 13.4562235