Managing nonvisually relevant cataracts in PAC
This management scenario—in which patients have nonvisually relevant cataracts and medically uncontrolled IOP after a LPI—is less clear. A 2013 study (Ophthalmology 2013; 120: 62-7) by Tham and colleagues looked at the results in patients who were randomized to phacoemulsification or trabeculectomy. The patients in both groups had similar IOP reductions before and after surgery. The results with trabeculectomy, as reported previously, showed the need for fewer medications but more complications developed. One-third of patients developed a visually relevant cataract. “After an LPI, cataract surgery in a patient with a nonvisually significant cataract with uncontrolled IOPs might be appropriate at times,” she said.
When considering lens extraction as an initial treatment in a patient with a nonvisually relevant cataract, Dr. Bhorade recounted a study (Ophthalmology 2002; 109: 1597-603) by Jacobi and colleagues of 43 eyes treated with either phacoemulsification or surgical PI. The investigators reported that the IOPs were significantly lower in the phacoemulsification group than in the PI group. However, more studies are needed to confirm this result.
Finally, a Cochrane review of retrospective and prospective studies indicated that there was a lack of evidence from any highly qualified randomized clinical trials to support if early lens extraction is superior to other treatments (Cochrane Databse Syst Rev 2006; 3:CD005555. DOI: 10.1002/14651858.CD005555.pub2).