RISKS ASSOCIATED WITH MEDICAL GLAUCOMA TREATMENT FOR CATARACT PATIENTS: A PROSPECTIVE OBSERVATIONAL COHORT STUDY
DOI:
https://doi.org/10.51168/sjhrafrica.v5i12.1446Keywords:
Glaucoma, Cataracts, Intraocular Pressure, Visual Acuity, Ocular Side EffectsAbstract
Background
Glaucoma and cataracts are common ocular conditions often found together, posing significant challenges in patient management. The concurrent presence of both conditions can complicate treatment strategies, as glaucoma medications may accelerate cataract formation. This study examines the impact of glaucoma treatment on cataract progression and visual outcomes.
Methods
This prospective observational cohort study at Mahaveer Institute of Medical Sciences, Telangana, enrolled 80 adults with glaucoma and cataracts. Participants received glaucoma treatment and were monitored for IOP, visual acuity, and cataract progression over six months. Data collected at baseline, 1, 3, and 6 months were analyzed using SPSS. Ethical approval and informed consent were obtained.
Results
The study included 80 participants with glaucoma and cataracts, with a mean age of 65.4 years. Cataract progression occurred in 35% of participants, with higher rates in those with more severe baseline cataracts. Intraocular pressure (IOP) decreased significantly from 24.1 mmHg at baseline to 16.8 mmHg at 6 months (p < 0.001). Visual acuity worsened considerably over the study period (p = 0.02). Ocular side effects were reported in 31.3% of participants, but these were not significantly correlated with specific glaucoma treatments (p > 0.05).
Conclusion
The study found that glaucoma medications significantly reduce intraocular pressure but may contribute to cataract progression and a decline in visual acuity. Ocular side effects were common, though not linked considerably to specific treatments.
Recommendation
We recommend lifelong annual examinations by an ophthalmologist for patients who have had surgery for cataracts. Future studies are needed to assess the long-term glaucoma risk for patients treated with current aspiration techniques.
References
Khan, J., & Shaw, S. (2023). Risk of cataract and glaucoma among older persons with diabetes in India: a cross-sectional study based on LASI, Wave-1. Scientific reports, 13(1), 11973. https://doi.org/10.1038/s41598-023-38229-z
Wojcik-Gryciuk, A., Skup, M., & Waleszczyk, W. J. (2016). Glaucoma state of the art and perspectives on treatment. Restorative neurology and neuroscience, 34(1), 107-123. https://doi.org/10.3233/RNN-150599
Lam, Dennis, Srinivas K. Rao, Vineet Ratra, Yizhi Liu, Paul Mitchell, Jonathan King, Marie-José Tassignon, Jost Jonas, Chi P. Pang, and David F. Chang. "Cataract." Nature Reviews Disease Primers 1, no. 1 (2015): 1-15. https://doi.org/10.1038/nrdp.2015.14
Bettin, P., & Di Matteo, F. (2013). Glaucoma: present challenges and future trends. Ophthalmic Research, 50(4), 197-208. https://doi.org/10.1159/000348736
Conlon, R., Saheb, H., & Ahmed, I. I. K. (2017). Glaucoma treatment trends: a review. Canadian Journal of Ophthalmology, 52(1), 114-124. https://doi.org/10.1016/j.jcjo.2016.07.013
Zhang, M. L., Hirunyachote, P., & Jampel, H. (2015). Combined surgery versus cataract surgery alone for eyes with cataracts and glaucoma. Cochrane Database of Systematic Reviews, (7). https://doi.org/10.1002/14651858.CD008671.pub3
Marchini, G., Ceruti, P., Vizzari, G., Berzaghi, D., & Zampieri, A. (2017). Management of concomitant cataract and glaucoma. Glaucoma surgery, 59, 155-164. https://doi.org/10.1159/000458494
Ling, J. D., & Bell, N. P. (2018). Role of cataract surgery in the management of glaucoma. International ophthalmology clinics, 58(3), 87-100. https://doi.org/10.1097/IIO.0000000000000234
Chan, P. P., Larson, M. D., Dickerson Jr, J. E., Mercieca, K., Koh, V. T. C., Lim, R., ... & Lam, D. S. (2023). Minimally invasive glaucoma surgery: latest developments and future challenges. The Asia-Pacific Journal of Ophthalmology, 12(6), 537-564. https://doi.org/10.1097/APO.0000000000000646
Samet, S., Ong, J. A., & Ahmed, I. I. K. (2019). Hydrus microstent implantation for surgical management of glaucoma: a review of design, efficacy and safety. Eye and Vision, 6, 1-13. https://doi.org/10.1186/s40662-019-0157-y
Sarkisian Jr, S. R., Grover, D. S., Gallardo, M. J., Brubaker, J. W., Giamporcaro, J. E., Hornbeak, D. M., ... & iStent Infinite Study Group. (2023). Effectiveness and safety of iStent infinite trabecular micro-bypass for uncontrolled glaucoma. Journal of glaucoma, 32(1), 9-18. https://doi.org/10.1097/IJG.0000000000002141
Giri, B. R., Jakka, D., Sandoval, M. A., Kulkarni, V. R., & Bao, Q. (2024). Advancements in Ocular Therapy: A Review of Emerging Drug Delivery Approaches and Pharmaceutical Technologies. Pharmaceutics, 16(10), 1325. https://doi.org/10.3390/pharmaceutics16101325
Tsakiris, K., Kontadakis, G., Georgoudis, P., Gatzioufas, Z., & Vergados, A. (2021). Surgical and perioperative considerations for the treatment of cataract in eyes with glaucoma: A literature review. Journal of Ophthalmology, 2021(1), 5575445. https://doi.org/10.1155/2021/5575445
Musch, D. C., Gillespie, B. W., Niziol, L. M., Janz, N. K., Wren, P. A., Rockwood, E. J., & Lichter, P. R. (2006). Cataract extraction in the collaborative initial glaucoma treatment study: incidence, risk factors, and the effect of cataract progression and extraction on clinical and quality-of-life outcomes. Archives of ophthalmology, 124(12), 1694-1700. https://doi.org/10.1001/archopht.124.12.1694
Radhakrishnan, S., Wan, J., Tran, B., Thai, A., Hernandez-Siman, J., Chen, K., ... & Iwach, A. G. (2020). Micropulse cyclophotocoagulation: a multicenter study of efficacy, safety, and factors associated with increased risk of complications. Journal of Glaucoma, 29(12), 1126-1131. https://doi.org/10.1097/IJG.0000000000001644
Shaarawy, T., Goldberg, I., & Fechtner, R. (2015). EX-PRESS glaucoma filtration device: review of clinical experience and comparison with trabeculectomy. Survey of ophthalmology, 60(4), 327-345. https://doi.org/10.1016/j.survophthal.2015.01.001
Adams, C. M., Stacy, R., Rangaswamy, N., Bigelow, C., Grosskreutz, C. L., & Prasanna, G. (2019). Glaucoma-next generation therapeutics: impossible to possible. Pharmaceutical research, 36, 1-17. https://doi.org/10.1007/s11095-018-2557-4
Ahmed, I. I. K., De Francesco, T., Rhee, D., McCabe, C., Flowers, B., Gazzard, G., ... & HORIZON Investigators. (2022). Long-term outcomes from the HORIZON randomized trial for a Schlemm's canal microstent in combination cataract and glaucoma surgery. Ophthalmology, 129(7), 742-751. https://doi.org/10.1016/j.ophtha.2022.02.021
Shaheen, A., Afflitto, G. G., & Swaminathan, S. S. (2024). Refractive outcomes following combined cataract and micro-invasive glaucoma surgery. Ophthalmology Glaucoma. https://doi.org/10.1016/j.ogla.2024.07.003
Laroche, D., & Madu, C. T. (2023). Preventing Blindness with Early Cataract Surgery and Micro-Invasive Glaucoma Surgery in Patients Over 50: Guidance for Patients, Physicians and World Governments in Dealing with Glaucoma. Clinical Ophthalmology, 2929-2938. https://doi.org/10.2147/OPTH.S422415
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Ratkal Ashwini Mallikarjun, Akshata Charlotte, Nalini Mahendraker
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.