Cataract surgery and IOP: a systematic review of randomised controlled trials

Purpose Cataract and glaucoma are two of the most common ocular comorbidities. Cataract surgery has been shown to influence intra-ocular pressure (TOP) in patients with glaucoma; nevertheless, the extent of this effect remains controversial, especially in patients with open-angle glaucoma (OAG). The aim of this review is to determine the real effect of cataract surgery on TOP change in patients with OAG, focusing on data retrieved from randomised controlled trials (RCTs). Methods A systematic review was performed, including six different RCTs that studied the net effect of cataract surgery on TOP. Eligibility criteria required a full washout from hypotensive therapy, allowing accurate measurement of unmedicated TOP, both before and after surgery. Results Included studies revealed a consistent reduction on TOP occurring after surgery, varying between 4.1 and 8 5 mmHg depending on the RCT. There was also a decrease in the number of glaucoma medications, with a mean reduction of 0.2-1.0 agents postoperatively. Evaluation of adverse outcomes of cataract surgery showed a very favourable safety profile. Conclusion Although the role of cataract surgery in the algorithm of glaucoma treatment remains to be established, this review highlights a consistent decrease on TOP following surgery and a reduced dependency on glaucoma medications. Potential downgrade in medication can thus be considered in well-controlled glaucoma patients after phacoemulsification.