Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Department of Ophthalmology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.
Ophthalmic Res. 2023;66(1):854-861. doi: 10.1159/000530072. Epub 2023 Mar 14.
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).
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.
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).
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.
本研究旨在评估白内障超声乳化术联合内眼环光凝术（phaco-ECP）对原发性开角型青光眼（POAG）患者眼压（IOP）波动的影响，通过饮水试验（WDT）进行评估。
这是一项在三级转诊中心进行的前瞻性观察研究。纳入了正在接受局部抗青光眼药物治疗并计划接受 phaco-ECP 的 POAG 患者。在手术前和术后 6 周进行 WDT，在 5 分钟内饮用 10 mL/kg 的水，然后使用 Goldmann 压平眼压计连续测量眼压，分别在 15、30、45 和 60 分钟测量眼压。分析平均眼压、眼压波动（最高眼压与最低眼压之间的差异）、眼压降低以及影响眼压波动的因素。
共纳入 17 名患者的 20 只眼。手术前后的基础眼压相似（分别为 14.7 ± 2.7 mm Hg 和 14.8 ± 3.4 mm Hg，p = 0.90）。平均眼压（分别为术前 17.6 ± 3.4 mm Hg 和术后 19.3 ± 4.7 mm Hg，p = 0.26）或最高眼压（分别为术前 19.37 ± 3.74 mm Hg 和术后 21.23 ± 5.29 mm Hg，p = 0.25）均无差异，但术后眼压降低药物的使用显著减少（分别为 2.2 ± 1.15 和 0.35 ± 0.93，p < 0.001）。术后眼压波动显著增加（分别为 6.4 ± 3.2 mm Hg 和 4.6 ± 2.1 mm Hg，p = 0.015），有更多的眼术后出现显著的眼压波动≥6 mm Hg（分别为 11 只眼[55%]和 4 只眼[20%]，p < 0.001）。与术后眼压波动增加显著相关的因素是较高的术前眼压波动（β = 0.69，95%CI 0.379-1.582，p = 0.004）和更多的术后抗青光眼药物（β = 0.627，95%CI 0.614-3.322，p = 0.008）。
白内障超声乳化术联合内眼环光凝术减少房水生成，但不能消除 POAG 患者的眼压波动。术后眼压波动增加表明 phaco-ECP 后流出阻力增加。
