Work

Impact of Lens Thickness on Outcomes After Cataract Versus Combined Cataract–Glaucoma Surgery in a Predominantly Black Population

Year: 2026

Type: article

Abstract: Background/Objectives: To evaluate the relationship between lens thickness (LT) and postoperative outcomes following cataract surgery versus combined cataract and glaucoma procedures in a predominantly Black and Caribbean population, and to assess the utility of LT and the Laroche Glaucoma Risk Calculator in predicting intraocular pressure (IOP) reduction. Methods: This retrospective cohort study included 187 eyes from patients aged ≥50 years who underwent cataract surgery alone or combined cataract and glaucoma surgery (goniotomy or Ahmed retrobulbar/intraconal tube at a single-center practice in Queens, New York. Preoperative and postoperative data at ≥3 months included IOP, visual acuity (logMAR), medication burden, visual field mean deviation, and anterior segment biometry measured with optical imaging. Patients were stratified by surgical type, diagnosis, and glaucoma risk. Associations between LT and postoperative IOP reduction were analyzed. Results: Mean LT across the cohort was 4.53 mm. Greater LT was consistently associated with increased postoperative IOP reduction across all surgical groups. Eyes with LT ≥4.5 mm demonstrated greater IOP reduction compared to those with LT ≤4.2 mm (2.63 ± 4.59 mmHg vs 1.19 ± 4.10 mmHg). Those with LT between 4.2-4.5 saw an average IOP reduction of -2.04 ± 3.80 mmHg. Combined procedures yielded greater IOP reduction than cataract surgery alone, with the largest decrease observed in the Ahmed group (−4.56 mmHg, 25%). Cataract surgery alone produced significant but smaller IOP reductions (−1.58 mmHg, 11%) and the greatest improvement in visual acuity. Medication burden decreased substantially in combined groups (80% in goniotomy, 47% in Ahmed). Patients with angle-closure glaucoma exhibited the highest LT. Stratification using the Laroche Glaucoma Risk Calculator showed that high-risk patients experienced greater IOP reduction following cataract surgery compared to low-risk patients (2.4 mmHg vs 1.09 mmHg, both statistically significant). Conclusions: Increased lens thickness may be associated with greater postoperative IOP reduction following both cataract and combined cataract–glaucoma surgery, showing its potential as a predictive biomarker. Combined procedures provide superior IOP and medication burden reduction, while cataract surgery alone offers meaningful benefit, particularly in high-risk patients. Incorporating LT analysis and the Laroche Glaucoma Calculator into preoperative assessment may improve surgical planning and outcome prediction, especially in underserved populations disproportionately affected by glaucoma.

Source: Journal of Clinical Medicine

DOI: 10.3390/jcm15135111

Authors: Devin Giordano, Jasmine Okafor, Daniel Laroche

Institution: Columbia University

Language: English

Topic: Glaucoma and retinal disorders

Subfield: Ophthalmology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,137