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Incidence of newly diagnosed glaucoma after phaco greater in eyes with pseudoexfoliation

SAN FRANCISCO — More new cases of glaucoma were diagnosed in pseudoexfoliation eyes compared with control eyes after phacoemulsification, according to 5-year results of the Aravind Pseudoexfoliation Study presented here.

“This is the first large-scale, long-term, prospective, comparative study evaluating pseudoexfoliation eyes undergoing phacoemulsification,” Emily Schehlein, MD, of Kellogg Eye Center, said at the American Glaucoma Society annual meeting. “We found that pseudoexfoliation without pre-existing phacodonesis or small pupils did not statistically confer an increased risk of IOL decentration, and this was unrelated to the presence of a capsular tension ring or IOL design. Patients with pseudoexfoliation had more PCO requiring capsulotomy, endothelial cell loss at the fifth year was similar in both groups, and the pseudoexfoliation group had a significantly increased incidence of glaucoma.”

The study was conducted at the Aravind Eye Care System in India and included 936 eyes with pseudoexfoliation and visually significant cataract. These eyes were randomized to receive either a one-piece acrylic IOL or a three-piece IOL, as well as to receive a capsular tension ring or not. The control group included 476 eyes with cataract but no pseudoexfoliation or other significant pathology randomized equally to receive a one-piece IOL or a three-piece IOL but no capsular tension ring.

Follow-up at 5 years included 76% of participants. Attrition was due mostly to deaths, Schehlein said.

“There was no significant difference in decentration rates between the pseudoexfoliation group and the control group when compared overall,” she said. “When we look specifically at pseudoexfoliation eyes, there was no significant difference in centration between one-piece IOLs and three-piece IOLs or having a capsular tension ring or not.”

There was a statistically significant difference (P = .029) in rates of Nd:YAG posterior capsulotomy required in pseudoexfoliation eyes (7.9%) compared with control eyes (4.5%).

Whereas endothelial cell density was statistically significantly less in pseudoexfoliation eyes at baseline (P < .001) and at 5 years (P = .0004), the rate of reduction between control eyes and pseudoexfoliation eyes at 5 years was similar.

“Very importantly, the incidence of newly diagnosed glaucoma was 7.4% in the pseudoexfoliation group compared to 1.8% in the control group (P < .0001),” Schehlein said.

Because the study was conducted in a large population only in India, the results may not be generalizable to a more diverse population, she said.

Schehlein was the 2019 recipient of the Bernard Schwartz, MD, Memorial Award, given at the annual meeting to the top scored paper or poster presented by a resident at the meeting. – by Patricia Nale, ELS

 

Reference:

Schehlein E. Postoperative complications and the incidence of glaucoma in eyes with and without pseudoexfoliation: Aravind Pseudoexfoliation Study – 5-year results. Presented at: American Glaucoma Society annual meeting; March 14-17, 2019; San Francisco.

Disclosure: Schehlein reports no relevant financial disclosures.

SAN FRANCISCO — More new cases of glaucoma were diagnosed in pseudoexfoliation eyes compared with control eyes after phacoemulsification, according to 5-year results of the Aravind Pseudoexfoliation Study presented here.

“This is the first large-scale, long-term, prospective, comparative study evaluating pseudoexfoliation eyes undergoing phacoemulsification,” Emily Schehlein, MD, of Kellogg Eye Center, said at the American Glaucoma Society annual meeting. “We found that pseudoexfoliation without pre-existing phacodonesis or small pupils did not statistically confer an increased risk of IOL decentration, and this was unrelated to the presence of a capsular tension ring or IOL design. Patients with pseudoexfoliation had more PCO requiring capsulotomy, endothelial cell loss at the fifth year was similar in both groups, and the pseudoexfoliation group had a significantly increased incidence of glaucoma.”

The study was conducted at the Aravind Eye Care System in India and included 936 eyes with pseudoexfoliation and visually significant cataract. These eyes were randomized to receive either a one-piece acrylic IOL or a three-piece IOL, as well as to receive a capsular tension ring or not. The control group included 476 eyes with cataract but no pseudoexfoliation or other significant pathology randomized equally to receive a one-piece IOL or a three-piece IOL but no capsular tension ring.

Follow-up at 5 years included 76% of participants. Attrition was due mostly to deaths, Schehlein said.

“There was no significant difference in decentration rates between the pseudoexfoliation group and the control group when compared overall,” she said. “When we look specifically at pseudoexfoliation eyes, there was no significant difference in centration between one-piece IOLs and three-piece IOLs or having a capsular tension ring or not.”

There was a statistically significant difference (P = .029) in rates of Nd:YAG posterior capsulotomy required in pseudoexfoliation eyes (7.9%) compared with control eyes (4.5%).

Whereas endothelial cell density was statistically significantly less in pseudoexfoliation eyes at baseline (P < .001) and at 5 years (P = .0004), the rate of reduction between control eyes and pseudoexfoliation eyes at 5 years was similar.

“Very importantly, the incidence of newly diagnosed glaucoma was 7.4% in the pseudoexfoliation group compared to 1.8% in the control group (P < .0001),” Schehlein said.

Because the study was conducted in a large population only in India, the results may not be generalizable to a more diverse population, she said.

Schehlein was the 2019 recipient of the Bernard Schwartz, MD, Memorial Award, given at the annual meeting to the top scored paper or poster presented by a resident at the meeting. – by Patricia Nale, ELS

 

Reference:

Schehlein E. Postoperative complications and the incidence of glaucoma in eyes with and without pseudoexfoliation: Aravind Pseudoexfoliation Study – 5-year results. Presented at: American Glaucoma Society annual meeting; March 14-17, 2019; San Francisco.

Disclosure: Schehlein reports no relevant financial disclosures.

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