If the IOP is medically uncontrolled after an LPI, Dr. Bhorade considers the same treatment scenario for these patients. Dr. Tham and colleagues also performed a study (Ophthalmology 2009; 116: 725-31) that included 51 eyes with uncontrolled IOP despite medical therapy and a visually relevant cataract. In this group, the combination therapy significantly lowered the IOP compared with the phacoemulsification group.
However, the result was the same as in the previously described group: Fewer IOP medications were needed postoperatively but there were more postoperative complications. “Cataract surgery alone might be indicated in these patients,” she said.
Another therapeutic course to consider is cataract surgery versus LPI as the initial treatment. In two previous studies, the eyes were randomized to one of the treatments. In one study (Ophthalmology 2008; 115: 1134-40), the mean IOP was lower in the phacoemulsification group than in the LPI group; in the second study (Ophthalmology 2012; 119: 2274-81), the 2-year cumulative survival rate was 89.5% in the phacoemulsification group compared with 61.1% in the LPI group.
“It appears that initial cataract surgery in patients with visually significant cataracts might be an appropriate treatment,” Dr. Bhorade commented.