Algorithm for predicting an increase in intraocular pressure after phacoemulsification in patients with primary open-angle glaucoma

PURPOSE. To create a predictive algorithm for identifying the risk of increased intraocular pressure (IOP) after phacoemulsification (PE) in patients with primary open-angle glaucoma (POAG), and to assess its effectiveness.

METHODS. The analysis of 132 eyes of patients with POAG with normalized IOP, which underwent PE, was carried out. During the observation period lasting up to 18 months after PE, 28 eyes (21%) showed an increase in IOP from 24 to 32 mm Hg. These patients made up the 1st group; the 2nd group consisted of 104 patients without elevated IOP at the indicated time. A comparative analysis of risk factors for increased IOP was carried out, which included the initial clinical and morphological characteristics of the anterior segment of the eyes, stages of POAG, methods of preoperative normalization of IOP.

RESULTS. Significant differences were revealed in the eyes of the 1st group in terms of the frequency of a combination of pseudoexfoliative syndrome (PES), rigid pupil, degree IV nucleus density, degree I lens subluxation (p<0.01), frequency of advanced stage of glaucoma, anterior chamber depth, lens thickness, duration of antihypertensive therapy (p<0.01). The method of logistic regression and ROC analysis was used to create and verify a predictive algorithm for identifying the risk of postoperative increase in IOP after PE based on these identified factors.

CONCLUSION. The developed predictive algorithm showed high sensitivity and specificity of 82%, making it useful for predicting an increase in IOP after PE in patients with POAG.

1. Krasnov M.M. About the target intraocular pressure. RMJ Clinical Ophthalmology. 2003; 4(2):49-51. (In Russ.)

2. Egorov E.A., Kuroedov A.V. Selected clinical and epidemiological characteristics of glaucoma in the CIS countries and Georgia. Results of a multicenter open retrospective study (part 1). RMJ Clinical Ophthalmology. 2011; 3:97-100. (In Russ.)

3. Erichev V.P., Kozlova I.V., Akopyan A.I. et al. Selective sympathomimetics in mono- and combination therapy of glaucoma. Natsional'nyi zhurnal glaukoma. 2015; 14(1):44-51. (In Russ.)

4. Harju M., Suominen S., Allinen P., Vesti E. Long-term results of deep sclerectomy in normal-tension glaucoma. Acta Ophthalmol. 2018; 96(2):154-160. doi: 10.1111/aos.13529

5. Avdeev R.V., Alexandrov A.S., Bakunina N.A. et al. Comparison of treatment regimens for patients with primary open-angle glaucoma with the characteristics of disease progression. Part 1. State of indicators of ophthalmotonus. Natsional'nyi zhurnal glaukoma. 2018; 17(1):14-28. (In Russ.) doi: 10.25700/NJG.2018.01.02

6. Nikolashin S.I., Fabrikantov O.L. Indications for dilation of a narrow rigid pupil during cataract phacoemulsification in glaucomatous eyes, depending on the initial state of the eye. Tambov University Reports. Series of Natural and Technical Sciences. 2014; 19(4):1186-1192. (In Russ.)

7. Pershin K.B., Pashinova N.F., Tsygankov A.Yu. et al. 15 years of experience in combined cataract and glaucoma surgery. Natsional'nyi zhurnal glaukoma. 2017; 16(2):38-46. (In Russ.)

8. Borkenstein A.F., Borkenstein E.M. Patient and surgeon satisfaction levels after using an acrylic, hydrophobic, monofocal IOL and the Malyugin ring in pseudoexfoliation syndrome patients [Электронный ресурс]. J Ophthalmol. 2018 May 15; 2018:3843098. doi: 10.1155/2018/3843098.

9. Drolsum L.K., Ringvold A., Nicolaissen B. Cataract and glaucoma surgery in pseudoexfoliation syndrome: a review. Acta ophthalmologica Scandinavica. 2007; 85(8):810-821. doi: 10.1111/j.1600-0420.2007.00903.x

10. Leung V.C., Singh H., Ahmed I.I. Inter-eye differences in patients with pseudoexfoliation syndrome presenting with intraocular lens dislocation. Ophthalmology. 2015; 122(3):480-485. doi: 10.1016/j.ophtha.2014.09.003

11. Shazly T.A., Farrag A.N., Kamel A., Al-Hussaini A. K. Prevalence of pseudoexfoliation syndrome and pseudoexfoliation glaucoma in Upper Egypt. BMC Ophthalmol. 2011; 11:18. doi: 10.1186/1471-2415-11-18

12. Jimenez-Roman J., Lazcano-Gomez G., Martínez-Baez K. Effect of phacoemulsification on intraocular pressure in patients with primary open angle glaucoma and pseudoexfoliation glaucoma. Int J Ophthalmol. 2017; 10(9):1374-1378. doi: 10.18240/ijo.2017.09.07

13. Kalizhnikova E.A., Lebedev O.I., Stepanova E.A., Trofimova E.I. Changes in the topography of the anterior segment of the eye and indicators of uveoscleral outflow in patients with primary glaucoma with cataract phacoemulsification. Natsional'nyi zhurnal glaucoma. 2015;14(4):21-28. (In Russ.)

14. Chen P.P., Lin S.C., Junk A.K. et al. The effect of phacoemulsification on intraocular pressure in glaucoma patients: a report by the American Academy of Ophthalmology. Ophthalmology. 2015; 122(7): 1294-1307. doi: 10.1016/j.ophtha.2015.03.021

15. Avetisov S.E., Erichev V.P., Kozlova I.V., Kosova D.V. Frequency of occurrence and possible causes of ophthalmic hypertension after phacoemulsification in patients with primary open-angle glaucoma. Natsional'nyi zhurnal glaucoma. 2017;16(3):63-69. (In Russ.)

16. Masis Solano M., Lin S.C. 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.2018.01.003

17. Perez C.I., Chansangpetch S., Feinstein M. et al. Novel gonioscopy score and predictive factors for intraocular pressure lowering after phacoemulsification. J Glaucoma. 2018; 27(7):622-626. doi: 10.1097/IJG.0000000000000976

18. Ginoyan A.A., Kopaev S.Yu., Kopaeva V.G. Laser cataract extraction on eyes with open-angle glaucoma. Vestnik of the Orenburg State University. 2013;4:63-65. (In Russ.)

19. Nikolashin S.I., Takhchidi H.P., Machekhin V.A. Microcoaxial phacoemulsification of cataracts in the eyes with compensated and operated glaucoma. Vestnik of the Orenburg State University. 2008;12:108-111. (In Russ.)

20. Slabaugh M.A., Bojikian K.D., Moore D.B., Chen P.P. The effect of phacoemulsification on intraocular pressure in medically controlled open-angle glaucoma patients. Am J Ophthalmol. 2014; 157(1):26-31. doi: 10.1016/j.ajo.2013.08.023

21. Wilczynski M., Omulecki W. Applications of various iris retractors. Klin Oczna. 2012; 114(4):321-323.

22. Papaconstantinou D., Kalantzis G., Brouzas D. et al. Safety and efficacy of phacoemulsification and intraocular lens implantation through a small pupil using minimal iris manipulation. Clin Interv Aging. 2016; 11:651-657. doi: 10.2147/CIA.S97254

23. Hashemi H., Seyedian M.A., Mohammadpour M. Small pupil and cataract surgery. Curr Opin Ophthalmol. 2015; 26(1):3-9. doi: 10.1097/ICU.0000000000000116

24. Borshuk E.L., Chuprov A.D., Begun D.N., Lositsky A.O. Assessment of the baseline characteristics of the patient and the medical organization for predicting operational complications in the surgical treatment of cataracts. Practical medicine. 2018; 3(114):38-42. (In Russ.)

25. Zharkin I.N., Sekacheva M.S. Analysis of the reasons for the transition to intracapsular extraction during planned surgery of age-related and complicated cataracts. Vestnik Bashkir State Medical University. 2017; 3:53-56 (In Russ.)

26. Postupaev A.V., Postupaeva N.V., Sorokin E.L., Egorov V.V. Surgical features of phacoemulsification of age-related cataract in background primary open-angle glaucoma. Tambov University Reports. Series: Natural and Technical Sciences. 2016; 21(4):1654-1657. (In Russ.) doi: 10.20310/1810-0198-2016-21-4-1654-1657

27. Postupaeva N.V., Postupaev A.V., Sorokin E.L., Egorov V.V. Method of capsulorhexis for rigid pupil during phacoemulsification in patients with glaucoma. RF patent No 2535779, 20.12.2014. Bulletin No 35. (In Russ.)

28. Sorokin E.L., Postupaeva N.V. Clinical and biochemical regularities of the eyes in combination with primary open-angle glaucoma with normalized IOP and age-related cataracts. Practical medicine. 2016; 6(98):163-167. (In Russ.)

29. Lebedev O.I., Belousova E.I., Kovalevsky V.V., Vykhodtseva O.G., Yavorsky A.E., Molchanova E.V., Surov A.V., Stolyarov G.M., Stepanova E.A. Method for determining indications for surgical treatment of cataracts and open-angle glaucoma. RF patent No 2413482, 10.03.2011. Bulletin No 7. (In Russ.)

30. Slabaugh M.A., Bojikian K.D., Moore D.B., Chen P.P. Risk factors for acute postoperative intraocular pressure elevation after phacoemulsification in glaucoma patients. J Cataract Refract Surg. 2014; 40(4):538-544. doi: 10.1016/j.jcrs.2013.08.048