Changes in Anterior Segment Morphology and Intraocular Pressure after Cataract Surgery in Non-glaucomatous Eyes

Abstract

Background It is known that cataract extraction is associated with a significant reduction in intraocular pressure, especially in narrow angled eyes; however, the modifications of anterior segment parameters associated with this phenomenon have still not been completely defined. The purpose of this study was to evaluate changes in anterior segment anatomy and intraocular pressure after cataract surgery in non-glaucomatous eyes.

Methods and Material This retrospective case series study included 64 eyes of 64 consecutive patients who underwent phacoemulsification with intraocular lens implantation. Anterior segment parameters and intraocular pressure were assessed and compared before and 6 months after surgery. Anterior segment imaging was performed using Casia SS-1000 anterior segment optical coherence tomography (Tomey, Nagoya, Japan). Anterior segment measurements included anterior chamber depth, anterior chamber width, anterior chamber volume, angle opening distance at 500 µm anterior to the scleral spur, angle recess area 750 µm from the scleral spur, lens vault, trabecular iris space area at 500 µm from the scleral spur, and trabecular iris angle at 500 µm from the scleral spur. Intraocular pressure was measured using the Goldmann applanation tonometer (Model AT 900 C/M, Haag-Streit, Bern, Switzerland). Anterior segment parameters and the relationship of changes in intraocular pressure were also evaluated.

Results All anterior segment parameters increased significantly after surgery (p < 0.05). Both angle opening distance at 500 µm anterior to the scleral spur and anterior chamber depth changes were positively correlated with the preoperative lens vault. The mean intraocular pressure significantly decreased from 14.91 mmHg (± 2.8 SD) to 12.91 mmHg (± 3.13 SD) (p < 0.001). Changes in intraocular pressure correlated negatively with values for the width of the preoperative anterior chamber (r = − 0.533; p = 0.001).

Conclusion Cataract surgery led to significant widening of the anterior chamber angle and lowering of intraocular pressure. Further investigations are needed to better understand whether anterior chamber width may be a new independent predictive factor for reduction in postoperative intraocular pressure.

Zusammenfassung

Hintergrund Es ist bekannt, dass die Kataraktextraktion mit einer signifikanten Senkung des Augeninnendrucks einhergeht, insbesondere bei engen Augenwinkeln; die mit diesem Phänomen verbundenen Modifikationen der Parameter des vorderen Segments sind jedoch noch nicht vollständig definiert. Der Zweck dieser Studie war es, Veränderungen in der Anatomie des vorderen Augenabschnitts und des Augeninnendrucks nach einer Kataraktoperation bei nicht glaukomatösen Augen zu bewerten.

Methoden und Material Diese retrospektive Fallserienstudie umfasste 64 Augen von 64 konsekutiven Patienten, die sich einer Phakoemulsifikation mit intraokularer Linsenimplantation unterzogen haben. Die Parameter des vorderen Segments und der Augeninnendruck wurden vor und 6 Monate nach der Operation bewertet und verglichen. Die Bildgebung des vorderen Segments wurde unter Verwendung des optischen Kohärenztomographen Casia SS-1000 (Tomey, Nagoya, Japan) durchgeführt. Die Messungen des vorderen Segments umfassten Vorderkammertiefe, Vorderkammerbreite, Vorderkammervolumen, Winkelöffnungsabstand bei 500 µm vor dem Skleralsporn, Winkelaussparungsbereich 750 µm vom Skleralsporn, Linsengewölbe, trabekulärer Irisraumbereich bei 500 µm von der Skleralsporn und trabekulärer Iriswinkel bei 500 µm vom Skleralsporn. Der Augeninnendruck wurde unter Verwendung eines Goldmann-Applanationstonometers (Modell AT 900 C/M; Haag-Streit, Bern, Schweiz) gemessen. Die Beziehung zwischen den Parametern des vorderen Segments und den Veränderungen des Augeninnendrucks wurde ebenfalls bewertet.

Ergebnisse Alle Vorderabschnittsparameter stiegen nach der Operation signifikant an (p < 0,05). Sowohl „Winkelöffnungsabstand bei 500 µm anterior zum Skleralsporn“, als auch Veränderungen der Vorderkammertiefe waren positiv mit der präoperativen Linsenwölbung korreliert. Der mittlere Augeninnendruck sank signifikant ab, von 14,91 mmHg (± 2,8 SD) auf 12,91 mmHg (± 3,13 SD) (p < 0,001). Veränderungen des Augeninnendrucks korrelierten negativ mit präoperativen Vorderkammerweitenwerten (r = − 0,533; p = 0,001).

Schlussfolgerung Die Kataraktoperation führte zu einer deutlichen Aufweitung des Vorderkammerwinkels und einer Senkung des Augeninnendrucks. Weitere Untersuchungen sind erforderlich, um besser zu verstehen, ob die Vorderkammerbreite ein neuer unabhängiger prädiktiver Faktor für die postoperative Augeninnendrucksenkung sein könnte.

Key words

intraocular pressure - cataract surgery - anterior segment OCT - anterior segment morphology

Schlüsselwörter

Augeninnendruck - Kataraktchirurgie - Vorderabschnitt-OCT - Morphologie des vorderen Segments

Publication History

Received: 16 September 2022

Accepted: 03 January 2023

Article published online:
25 April 2023

• References

• 1 Kurimoto Y, Park M, Sakaue H. et al. Changes in the anterior chamber configuration after small-incision cataract surgery with posterior chamber intraocular lens implantation. Am J Ophthalmol 1997; 124: 775-780 DOI: 10.1016/S0002-9394(14)71694-0.
• 2 Tai MC, Chien KH, Lu DW. et al. Angle changes before and after cataract surgery assessed by Fourier-domain anterior segment optical coherence tomography. J Cataract Refract Surg 2010; 36: 1758-1762 DOI: 10.1016/j.jcrs.2010.05.011.
• 3 Uçakhan ÖÖ, Özkan M, Kanpolat A. Anterior chamber parameters measured by the Pentacam CES after uneventful phacoemulsification in normotensive eyes. Acta Ophthalmol 2009; 87: 544-548 DOI: 10.1111/j.1755-3768.2008.01305.x.
• 4 Hayashi K, Hayashi H, Nakao F. et al. Changes in anterior chamber angle width and depth after intraocular lens. Ophthalmology 2009; 6420: 698-703 DOI: 10.1016/S0161-6420(00)00007-5.
• 5 Hsia YC, Moghimi S, Coh P. et al. Anterior segment parameters as predictors of intraocular pressure reduction after phacoemulsification in eyes with open-angle glaucoma. J Cataract Refract Surg 2017; 43: 879-885 DOI: 10.1016/j.jcrs.2017.03.044.
• 6 Tham CCY, Kwong YYY, Leung DYL. et al. Phacoemulsification vs. phacotrabeculectomy in chronic angle-closure glaucoma with cataract complications. Arch Ophthalmol 2010; 128: 303-311 DOI: 10.1001/archophthalmol.2010.12.
• 7 Dooley I, Charalampidou S, Malik A. et al. Changes in intraocular pressure and anterior segment morphometry after uneventful phacoemulsification cataract surgery. Eye 2010; 24: 519-527 DOI: 10.1038/eye.2009.339.
• 8 Huang G, Gonzalez E, Peng PH. et al. Anterior chamber depth, iridocorneal angle width, and intraocular pressure changes after phacoemulsification narrow vs. open iridocorneal angles. Arch Ophthalmol 2011; 129: 1283-1290 DOI: 10.1001/archophthalmol.2011.272.
• 9 Moghimi S, Abdi F, Latifi G. et al. Lens parameters as predictors of intraocular pressure changes after phacoemulsification. Eye (Lond) 2015; 29: 1469-1476 DOI: 10.1038/eye.2015.141.
• 10 Guan H, Mick A, Porco T. et al. Preoperative factors associated with IOP reduction after cataract surgery. Optom Vis Sci 2013; 90: 179-184 DOI: 10.1097/OPX.0b013e31827ce224.
• 11 Lai JSM, Tham CCY, Chan JCH. The clinical outcomes of cataract extraction by phacoemulsification in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract: a prospective case series. J Glaucoma 2006; 15: 47-52 DOI: 10.1097/01.ijg.0000196619.34368.0a.
• 12 Cho YK. Early intraocular pressure and anterior chamber depth changes after phacoemulsification and intraocular lens implantation in nonglaucomatous eyes. Comparison of groups stratified by axial length. J Cataract Refract Surg 2008; 34: 1104-1109 DOI: 10.1016/j.jcrs.2008.03.023.
• 13 Shin HC, Subrayan V, Tajunisah I. Changes in anterior chamber depth and intraocular pressure after phacoemulsification in eyes with occludable angles. J Cataract Refract Surg 2010; 36: 1289-1295 DOI: 10.1016/j.jcrs.2010.02.024.
• 14 Mathalone N, Hyams M, Neiman S. et al. Long-term intraocular pressure control after clear corneal phacoemulsification in glaucoma patients. J Cataract Refract Surg 2005; 31: 479-483 DOI: 10.1016/j.jcrs.2004.06.046.
• 15 Poley BJ, Lindstrom RL, Samuelson TW. et al. Intraocular pressure reduction after phacoemulsification with intraocular lens implantation in glaucomatous and nonglaucomatous eyes. Evaluation of a causal relationship between the natural lens and open-angle glaucoma. J Cataract Refract Surg 2009; 35: 1946-1955 DOI: 10.1016/j.jcrs.2009.05.061.
• 16 Lee SJ, Lee CK, Kim WS. Long-term therapeutic efficacy of phacoemulsification with intraocular lens implantation in patients with phacomorphic glaucoma. J Cataract Refract Surg 2010; 36: 783-789 DOI: 10.1016/j.jcrs.2009.11.023.
• 17 Zhuo Y, Wang M, Li Y. et al. Phacoemulsification treatment of subjects with acute primary angle closure and chronic primary angle-closure glaucoma. J Glaucoma 2009; 18: 646-651 DOI: 10.1097/IJG.0b013e31819c4322.
• 18 Tarongoy P, Ho CL, Walton DS. Angle-closure glaucoma: the role of the lens in the pathogenesis, prevention, and treatment. Surv Ophthalmol 2009; 54: 211-225 DOI: 10.1016/j.survophthal.2008.12.002.
• 19 Doganay S, Bozgul Firat P Emre S. et al. Evaluation of anterior segment parameter changes using the Pentacam after uneventful phacoemulsification. Acta Ophthalmol 2010; 88: 601-606 DOI: 10.1111/j.1755-3768.2008.01446.x.
• 20 Altan C, Bayraktar S, Altan T. et al. Anterior chamber depth, iridocorneal angle width, and intraocular pressure changes after uneventful phacoemulsification in eyes without glaucoma and with open iridocorneal angles. J Cataract Refract Surg 2004; 30: 832-838 DOI: 10.1016/j.jcrs.2003.08.023.
• 21 Issa SA, Pacheco J, Mahmood U. et al. A novel index for predicting intraocular pressure reduction following cataract surgery. Br J Ophthalmol 2005; 89: 543-546 DOI: 10.1136/bjo.2004.047662.
• 22 Masis Solano M, Lin SC. Cataract, phacoemulsification and intraocular pressure: Is the anterior segment anatomy the missing piece of the puzzle?. Prog Retin Eye Res 2018; 64: 77-83 DOI: 10.1016/j.preteyeres.2018.01.03.
• 23 Kashiwagi K, Kashiwagi F, Tsukahara S. Effects of small-incision phacoemulsification and intraocular lens implantation on anterior chamber depth and intraocular pressure. J Glaucoma 2006; 15: 103-109 DOI: 10.1097/00061198-200604000-00005.
• 24 Perez CI, Chansangpetch S, Feinstein M. et al. Novel Gonioscopy Score and Predictive Factors for Intraocular Pressure Lowering After Phacoemulsification. J Glaucoma 2018; 27: 622-626 DOI: 10.1097/IJG.0000000000000976.
• 25 Lin SC, Masis M, Porco TC. et al. Predictors of Intraocular Pressure After Phacoemulsification in Primary Open-Angle Glaucoma Eyes with Wide Versus Narrower Angles (An American Ophthalmological Society Thesis). Trans Am Ophthalmol Soc 2017; 115: T6
• 26 Zhao Z, Zhu X, He W. et al. Schlemmʼs Canal Expansion After Uncomplicated Phacoemulsification Surgery: An Optical Coherence Tomography Study. Investig Opthalmology Vis Sci 2016; 57: 6507 DOI: 10.1167/iovs.16-20583.
• 27 Singh P, Tyagi M, Kumar Y. et al. Gonioscopy: A review. Open J Ophthalmol 2013; 3: 118-121 DOI: 10.4236/ojoph.2013.34025.
• 28 Melese E, Peterson JR, Feldman RM. et al. Comparing laser peripheral iridotomy to cataract extraction in narrow angle eyes using anterior segment optical coherence tomography. PLoS One 2016; 11: e0162283 DOI: 10.1371/journal.pone.0162283.
• 29 Peterson JR, Blieden LS, Chuang AZ. et al. Establishing age-adjusted reference ranges for iris-related parameters in open angle eyes with anterior segment optical coherence tomography. PLoS One 2016; 11: e0147760 DOI: 10.1371/journal.pone.0147760.
• 30 Liu S, Yu M, Ye C. et al. Anterior chamber angle imaging with swept-source optical coherence tomography: An investigation on variability of angle measurement. Investig Ophthalmol Vis Sci 2011; 52: 8598-8603 DOI: 10.1167/iovs.11-7507.
• 31 Rigi M, Blieden LS, Nguyen D. et al. Trabecular-iris circumference volume in open angle eyes using swept-source fourier domain anterior segment optical coherence tomography. J Ophthalmol 2014; 2014: 1-6 DOI: 10.1155/2014/590978.
• 32 Cumba RJ, Radhakrishnan S, Bell NP. et al. Reproducibility of scleral spur identification and angle measurements using fourier domain anterior segment optical coherence tomography. J Ophthalmol 2012; 2012: 487309 DOI: 10.1155/2012/487309.
• 33 Lee W, Bae HW, Kim CY. et al. The change of anterior segment parameters after cataract surgery in normal-tension glaucoma. Int J Ophthalmol 2017; 10: 1239-1245 DOI: 10.18240/ijo.2017.08.09.
• 34 Shingleton BJ, Gamell LS, OʼDonoghue MW. et al. Long-term changes in intraocular pressure after clear corneal phacoemulsification: Normal patients versus glaucoma suspect and glaucoma patients. J Cataract Refract Surg 1999; 25: 885-890 DOI: 10.1016/S0886-3350(99)00107-8.
• 35 Hsu CH, Kakigi CL, Lin SC. et al. Lens position parameters as predictors of intraocular pressure reduction after cataract surgery in nonglaucomatous patients with open angles. Investig Ophthalmol Vis Sci 2015; 56: 7807-7813 DOI: 10.1167/iovs.15-17926.
• 36 Nongpiur ME, He M, Amerasinghe N. et al. Lens vault, thickness, and position in Chinese subjects with angle closure. Ophthalmology 2011; 118: 474-479 DOI: 10.1016/j.ophtha.2010.07.025.
• 37 Huang G, Gonzalez E, Lee R. et al. Association of biometric factors with anterior chamber angle widening and intraocular pressure reduction after uneventful phacoemulsification for cataract. J Cataract Refract Surg 2012; 38: 108-116 DOI: 10.1016/j.jcrs.2011.06.037.
• 38 Nongpiur ME, Sakata LM, Friedman DS. et al. Novel association of smaller anterior chamber width with angle closure in Singaporeans. Ophthalmology 2010; 117: 1967-1973 DOI: 10.1016/j.ophtha.2010.02.007.
• 39 Dada T, Rathi A, Angmo D. et al. Clinical outcomes of clear lens extraction in eyes with primary angle closure. J Cataract Refract Surg 2015; 41: 1470-1477 DOI: 10.1016/j.jcrs.2014.10.029.
• 40 Yang HS, Lee J, Choi S. Ocular biometric parameters associated with intraocular pressure reduction after cataract surgery in normal eyes. Am J Ophthalmol 2013; 156: 89-94.e1 DOI: 10.1016/j.ajo.2013.02.003.
• 41 Kim M, Park KH, Kim TW. et al. Changes in anterior chamber configuration after cataract surgery as measured by anterior segment optical coherence tomography. Korean J Ophthalmol 2011; 25: 77-83 DOI: 10.3341/kjo.2011.25.2.77.
• 42 Han SB, Liu YC, Noriega KM. et al. Applications of Anterior Segment Optical Coherence Tomography in Cornea and Ocular Surface Diseases. J Ophthalmol 2016; 2016: 4971572 DOI: 10.1155/2016/4971572.