Diurnal Curve after Phacoemulsification in Patients with Pseudoexfoliation Syndrome and Cataract

PURPOSE: To evaluate the effect of phacoemulsification on the diurnal curve in patients with pseudoexfoliation syndrome. METHOD: 2052 patients aged 40 years and older attending our OPD services were screened, of whom 62 patients with pseudoexfoliation and associated significant cataract were selected for the study. All underwent a detailed examination including slit lamp examination, IOP, gonioscopy, and fundus examination. Diurnal variation of intraocular pressure was done at baseline and two and four weeks after phacoemulsification with IOL implantation. The IOP differences after surgery were compared and analyzed. RESULTS: All 62 patients underwent successful phacoemulsification with IOL implantation. Anterior chamber IOL was implanted in 2 of the 6 cases with vitreous loss. The peak IOP of the diurnal curve reduced from 26 ± 3.2 mmHg pre surgery to 19 ± 1.2 mmHg, p < 0.01, while the mean baseline IOP reduced from 22 ± 5.3 mmHg to 15 ± 2.1 mmHg at 2 months after cataract extraction, p = 0.02. The IOP fluctuations (max-min IOP difference) in the diurnal curve also flattened significantly post-surgery in eyes with both open and occludable angles, p < 0.01, with the maximum difference observed during the later part of the day in both groups. CONCLUSIONS: Early cataract extraction with IOL can smooth out intraocular pressure fluctuations in patients with pseudoexfoliation and associated cataract with open or narrow angles.