For a study, researchers sought to compare changes in intraocular pressure (IOP) and ocular hypotensive medications after cataract surgery, cataract surgery with trabecular micro-bypass (cataract/trabecular), and cataract surgery with goniotomy (cataract/goniotomy). Investigators included 138 open-angle glaucoma eyes: 84 with cataract surgery alone, 25 with cataract/trabecular surgery, and 29 with cataract/goniotomy surgery. The groups were compared in postoperative IOP and the number of ocular hypotensive medications used. They controlled for preoperative IOP and the number of ocular hypotensive medications used before and after surgery. On a postoperative day 1, the study group defined an IOP spike as IOP 21 mm Hg and 10 mm Hg higher than preoperative. When compared to their preoperative baselines, all 3 surgeries showed a decrease in IOP (P≤0.004) and medication burden (P≤0.001) at 3 and 6 months postoperatively. When compared to cataract surgery alone, cataract/trabecular and cataract/goniotomy had comparable IOP reductions at 1 month and variable results at 3 and 6 months. The change in ocular hypotensive medications was not statistically different between the surgical groups at any postoperative visit. Cataract/trabecular and cataract/goniotomy had a relative risk reduction of ~70% for IOP spikes on postoperative day 1 (P≤0.001 for both). Compared to cataract surgery alone, trabecular micro-bypass and goniotomy resulted in a large decrease in IOP spikes, a modest effect on IOP, and a minimal effect on medication burden in glaucoma patients.
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