Journal of glaucoma · 2026
Preoperative Factors Correlating With Intraocular Pressure Reduction After Phacoemulsification in Primary Angle Closure Glaucoma.
СтатьяНазвание и аннотация: Перевод в очереди
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Ling Anni, Chan Noel Cy, Li Sophia L, Tsui Jolly Ly, Lai Isabel Sw, Baig Nafees B, Kwong Yolanda Yy, Wong Mandy Om, Chow Claire Wy, Chan Poemen Pm, Cheung Carol Y, Tham Clement C
Аннотация
PRCIS: Phacoemulsification achieved a clinically significant 20% reduction in IOP in PACG. A novel predictive model incorporating preoperative IOP and SS-OCT anterior segment parameters demonstrated good diagnostic accuracy (AUC=0.78).
AIMS: To identify preoperative clinical and anatomic parameters that correlate with intraocular pressure (IOP) reduction after phacoemulsification in primary angle closure glaucoma (PACG) eyes.
METHODS: This prospective cohort study recruited 149 PACG eyes from 149 Chinese patients who underwent phacoemulsification from 2015-2020 in a glaucoma clinic in Hong Kong. Anterior segment swept-source optical coherence tomography (SS-OCT) was performed in both darkness and room light before and at 6 months after surgery. Preoperative clinical and SS-OCT parameters were evaluated using generalized estimating equations (GEE) to assess their correlation with postoperative IOP changes. A linear discriminant function (LDF) was generated with a teaching set and tested in a validating set. The performance was evaluated with receiver operating characteristic curves.
RESULTS: Cataract surgery alone effectively deepened the anterior chamber and widened the drainage angle, resulting in an average 20% reduction in IOP. Higher preoperative IOP predicted a greater absolute reduction in IOP at 6 months ( β =-0.73, P <0.001) and 12 months ( β =-0.76, P <0.001) after lens extraction. Preoperative iridotrabecular contact (ITC) area, lens vault (LV), anterior chamber depth (ACD), iris rotation (IR), and ITC length correlated significantly with absolute postoperative IOP reduction. Age, sex, history of prior laser peripheral iridotomy (LPI), and baseline visual field (VF) did not show a significant correlation with IOP reduction after phacoemulsification. Based on these findings, we generated a mathematical formula (LDF) to predict IOP reduction after phacoemulsification in PACG eyes: -10.596+0.23 × preoperative IOP + 2.07 × ITC length + 1.16 × LV + 0.90 × ACD + 0.04 × IR. The Receiver operating characteristic (ROC) curves in a separate validation sample were 0.78 (95% CI: 0.67-0.88) at 6 months and 0.70 (95% CI: 0.58-0.83) at 12 months.
CONCLUSION: Preoperative SS-OCT-based anatomic parameters correlated significantly with IOP reduction after phacoemulsification in PACG. The derived LDF, based on these parameters, may help predict IOP reduction and guide clinicians in determining which PACG patients may need additional IOP-lowering procedures in combination with phacoemulsification.
AIMS: To identify preoperative clinical and anatomic parameters that correlate with intraocular pressure (IOP) reduction after phacoemulsification in primary angle closure glaucoma (PACG) eyes.
METHODS: This prospective cohort study recruited 149 PACG eyes from 149 Chinese patients who underwent phacoemulsification from 2015-2020 in a glaucoma clinic in Hong Kong. Anterior segment swept-source optical coherence tomography (SS-OCT) was performed in both darkness and room light before and at 6 months after surgery. Preoperative clinical and SS-OCT parameters were evaluated using generalized estimating equations (GEE) to assess their correlation with postoperative IOP changes. A linear discriminant function (LDF) was generated with a teaching set and tested in a validating set. The performance was evaluated with receiver operating characteristic curves.
RESULTS: Cataract surgery alone effectively deepened the anterior chamber and widened the drainage angle, resulting in an average 20% reduction in IOP. Higher preoperative IOP predicted a greater absolute reduction in IOP at 6 months ( β =-0.73, P <0.001) and 12 months ( β =-0.76, P <0.001) after lens extraction. Preoperative iridotrabecular contact (ITC) area, lens vault (LV), anterior chamber depth (ACD), iris rotation (IR), and ITC length correlated significantly with absolute postoperative IOP reduction. Age, sex, history of prior laser peripheral iridotomy (LPI), and baseline visual field (VF) did not show a significant correlation with IOP reduction after phacoemulsification. Based on these findings, we generated a mathematical formula (LDF) to predict IOP reduction after phacoemulsification in PACG eyes: -10.596+0.23 × preoperative IOP + 2.07 × ITC length + 1.16 × LV + 0.90 × ACD + 0.04 × IR. The Receiver operating characteristic (ROC) curves in a separate validation sample were 0.78 (95% CI: 0.67-0.88) at 6 months and 0.70 (95% CI: 0.58-0.83) at 12 months.
CONCLUSION: Preoperative SS-OCT-based anatomic parameters correlated significantly with IOP reduction after phacoemulsification in PACG. The derived LDF, based on these parameters, may help predict IOP reduction and guide clinicians in determining which PACG patients may need additional IOP-lowering procedures in combination with phacoemulsification.