Article Text

Download PDFPDF
Predictors of intraocular pressure change after phacoemulsification in patients with pseudoexfoliation syndrome
  1. Sasan Moghimi1,2,
  2. Mohammadkarim Johari1,
  3. Alireza Mahmoudi1,
  4. Rebecca Chen2,3,
  5. Mehdi Mazloumi1,
  6. Mingguang He4,
  7. Shan C Lin2
  1. 1Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
  2. 2Beckman Vision Center, University of California, San Francisco, California, USA
  3. 3Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
  4. 4Department of Ophthalmology, University of Melbourne, Melbourne, Australia
  1. Correspondence to Dr Shan C Lin, Koret Vision Center, University of California, San Francisco Medical School, San Francisco, CA 94143-0730, USA; lins{at}


Aim To evaluate anterior chamber biometric factors and intraoperative metrics associated with the intraocular pressure (IOP) reduction after phacoemulsification in non-glaucomatous pseudoexfoliative syndrome (PXS) eyes.

Method Thirty-three patients were enrolled in this prospective interventional study. Images were excluded if they had poor quality, poor perpendicularity or inability to locate sclera spurs. Anterior chamber depth (ACD), anterior chamber area (ACA), iris thickness, iris area, iris curvature, lens vault, angle opening distance (AOD500, AOD750) and trabecular iris space area (TISA500, TISA750) were measured in qualified images using the Zhongshan Angle Assessment Program and compared preoperatively and 3 months postoperatively. Cumulative dissipated energy (CDE), aspiration time and infusion fluid usage during cataract surgery were obtained from the phacoemulsification machine's metrics record. Postoperative IOP change was compared with these anatomical and intraoperative metric parameters.

Results Mean IOP was 18.1±3.4 mm Hg preoperatively and decreased by 3.3 mm Hg (18%) to 14.8±3.6 mm Hg at 3 months postoperatively (p<0.001). All angle parameters, ACD and ACA increased significantly postoperatively (p<0.001 for all) and iris curvature decreased (p<0.001). In univariate analysis, preoperative IOP (B=−0.668, p=0.002), infusion fluid usage (B=−0.040, p=0.04) and aspiration time (B=−0.045, p=0.003) were negatively associated with IOP decrease after phacoemulsification. Changes in IOP did not demonstrate significant associations with CDE measurements or anterior segment optical coherence tomography measurements, including preoperative angle, iris or anterior segment parameters. In the final multivariate regression model, preoperative IOP (B=−0.668, p=0.002) and infusion fluid usage (B=−0.041, p=0.04) were significantly associated with IOP drop and together can predict 45.1% (p=0.002) of the variability in IOP change.

Conclusions Non-glaucomatous patients with PXS experience moderate IOP reduction following phacoemulsification, and this effect is correlated with preoperative IOP, aspiration time and infusion fluid used intraoperatively.

  • Glaucoma
  • Angle
  • Intraocular pressure

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors Involved in conception and design of study (SM and SCL); data collection (SM, MJ, AM and MM); analysis and interpretation of data (MJ, SM, AM, RC and SCL); provision of materials, patients or resources (SM and MH); statistical expertise (SM, RC and MJ); literature search (RC and SM); administrative, technical or logistic support (SM); writing the article (SM); critical revision of article (RC) and final approval of it (all authors). The protocol of the study was approved by the institutional review board of Farabi Eye Hospital, Tehran, Iran. Written informed consent was obtained from all the participants after complete explanation.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Farabi Eye Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles

  • At a glance
    Keith Barton James Chodosh Jost Jonas