Journal of Ophthalmic and Vision Research

Published date: Dec 08 2025

Journal Title: Journal of Ophthalmic and Vision Research

Issue title: ‎Volume 20 - 2025

Pages: 1 - 9

DOI: 10.18502/jovr.v20.17557

Ashley H. Yaskanichaeh0023@mix.wvu.eduWest Virginia University School of Medicine, Morgantown, WV

Wei Fangfehbdoc@gmail.comWest Virginia Clinical and Translational Science Institute, Morgantown, WV

Ibrahim Elwarfalliieelwarfalli@mix.wvu.eduWest Virginia University School of Medicine, Morgantown, WV

Joel R. Palkojoel.palko@hsc.wvu.eduWest Virginia University School of Medicine, Morgantown, WV

Purpose: To evaluate the influence of preoperative ocular and systemic variables on intraocular pressure (IOP) change following phacoemulsification cataract extraction with intraocular lens (CEIOL) implantation in eyes without glaucoma.

Methods: This retrospective cohort study included adults who underwent standalone CEIOL at a single academic center between 2017 and 2020. Preoperative demographic, ocular, and systemic health data were extracted from electronic health records using an informatics-based approach and validated by chart review. Eyes with glaucoma or other preoperative ocular conditions known to affect IOP were excluded. Postoperative IOP data were collected for up to 2 years and censored at the time of any subsequent diagnosis or treatment likely to influence IOP. A linear mixed-effects model was used to assess associations between IOP change and preoperative ocular (e.g., IOP, axial length, central corneal thickness) and systemic variables (e.g., diabetes, body mass index [BMI], smoking status), accounting for inter-eye correlation.

Results: A total of 1992 eyes from 1755 patients were included. Higher preoperative IOP (β = –0.563, P < 0.001) and female gender (β = –0.229, P = 0.005) predicted greater postoperative IOP reduction. Longer axial length (β = 0.201, P < 0.001), diabetes mellitus (β = 0.291, P = 0.019), thicker cornea (β = 0.008, P < 0.001), and higher BMI (β = 0.022, P = 0.005) were associated with a relative increase in postoperative IOP.

Conclusion: Both ocular and systemic variables significantly influenced postoperative IOP change following CEIOL in non-glaucomatous eyes. Understanding these associations may improve clinical decision-making and help tailor IOP-related counseling for patients undergoing cataract surgery.

Keywords: Cataract Extraction, Intraocular Pressure, Phacoemulsification

1. Leal I, Chu CJ, Yang YY, Manasses DM, Sebastian RT, Sparrow JM. Intraocular pressure reduction after realworld cataract surgery. J Glaucoma 2020;29:689–693.

2. Sengupta S, Venkatesh R, Krishnamurthy P, Nath M, Mashruwala A, Ramulu PY, et al. Intraocular pressure reduction after phacoemulsification versus manual smallincision cataract surgery: A randomized controlled trial. Ophthalmology 2016;123:1695–1703.

3. Guan H, Mick A, Porco T, Dolan BJ. Preoperative factors associated with IOP reduction after cataract surgery. Optom Vis Sci 2013;90:179–184.

4. Brown RH, Zhong L, Whitman AL, Lynch MG, Kilgo PD, Hovis KL. Reduced intraocular pressure after cataract surgery in patients with narrow angles and chronic angleclosure glaucoma. J Cataract Refract Surg 2014;40:1610– 1614.

5. Wang SY, Azad AD, Lin SC, Hernandez-Boussard T, Pershing S. Intraocular pressure changes after cataract surgery in patients with and without glaucoma: An informatics-based approach. Ophthalmol Glaucoma 2020;3:343–349.

6. Hayashi K, Hayashi H, Nakao F, Hayashi F. Effect of cataract surgery on intraocular pressure control in glaucoma patients. J Cataract Refract Surg 2001;27:1779– 1786.

7. Huang G, Gonzalez E, Lee R, Chen YC, He M, Lin SC. Association of biometric factors with anterior chamber angle widening and intraocular pressure reduction after uneventful phacoemulsification for cataract. J Cataract Refract Surg 2012;38:108–116.

8. Wang N, Chintala SK, Fini ME, Schuman JS. Ultrasound activates the TM ELAM-1/IL-1/NF-kappaB response: A potential mechanism for intraocular pressure reduction after phacoemulsification. Invest Ophthalmol Vis Sci 2003;44:1977–1981.

9. Yang HS, Lee J, Choi S. Ocular biometric parameters associated with intraocular pressure reduction after cataract surgery in normal eyes. Am J Ophthalmol 2013;156:89–94.e1.

10. Coh P, Moghimi S, Chen RI, Hsu CH, Masís Solano M, Porco T, et al. Lens position parameters as predictors of intraocular pressure reduction after cataract surgery in glaucomatous versus nonglaucomatous eyes. Invest Ophthalmol Vis Sci 2016;57:2593–2599.

11. Poley BJ, Lindstrom RL, Samuelson TW, Schulze R Jr. Intraocular pressure reduction after phacoemulsification with intraocular lens implantation in glaucomatous and nonglaucomatous eyes: Evaluation of a causal relationship between the natural lens and open-angle glaucoma. J Cataract Refract Surg 2009;35:1946–1955.

12. Al-Holou SN, Havens SJ, Treadwell GG, Ghate D, Toris CB, Gulati V. Predictors of intraocular pressure lowering after phacoemulsification and iStent implantation. Ophthalmol Glaucoma 2021;4:139–148.

13. Hsu CH, Kakigi CL, Lin SC, Wang YH, Porco T, Lin SC. Lens position parameters as predictors of intraocular pressure reduction after cataract surgery in nonglaucomatous patients with open angles. Invest Ophthalmol Vis Sci 2015;56:7807–7813.

14. DeVience E, Chaudhry S, Saeedi OJ. Effect of intraoperative factors on IOP reduction after phacoemulsification. Int Ophthalmol 2017;37:63–70.

15. Mori K, Ando F, Nomura H, Sato Y, Shimokata H. Relationship between intraocular pressure and obesity in Japan. Int J Epidemiol 2000;29:661–666.

16. Panon N, Luangsawang K, Rugaber C, Tongchit T, Thongsepee N, Cheaha D, et al. Correlation between body mass index and ocular parameters. Clin Ophthalmol 2019;13:763–769.

17. Lee AJ, Rochtchina E, Wang JJ, Healey PR, Mitchell P. Does smoking affect intraocular pressure? Findings from the Blue Mountains Eye Study. J Glaucoma 2003;12:209– 212.

18. Yasukawa T, Hanyuda A, Yamagishi K, Yuki K, Uchino M, Ozawa Y, et al. Relationship between blood pressure and intraocular pressure in the JPHC-NEXT eye study. Sci Rep 2022;12:17493.

19. Luo XY, Tan NY, Chee ML, Shi Y, Tham YC, Wong TY, et al. Direct and indirect associations between diabetes and intraocular pressure: The Singapore Epidemiology of Eye Diseases Study. Invest Ophthalmol Vis Sci 2018;59:2205– 2211.

20. Oshitari T, Fujimoto N, Hanawa K, Adachi-Usami E, Roy S. Effect of chronic hyperglycemia on intraocular pressure in patients with diabetes. Am J Ophthalmol 2007;143:363– 365.

21. Chua J, Chee ML, Chin CW, Tham YC, Tan N, Lim SH, et al. Inter-relationship between ageing, body mass index, diabetes, systemic blood pressure and intraocular pressure in Asians: 6-year longitudinal study. Br J Ophthalmol 2019;103:196–202.

22. Barak A, Desatnik H, Ma-Naim T, Ashkenasi I, Neufeld A, Melamed S. Early postoperative intraocular pressure pattern in glaucomatous and nonglaucomatous patients. J Cataract Refract Surg 1996;22:607–611.

23. Kim JY, Jo MW, Brauner SC, Ferrufino-Ponce Z, Ali R, Cremers SL, et al. Increased intraocular pressure on the first postoperative day following resident-performed cataract surgery. Eye 2011;25:929–936.

24. Bhorade AM, Gordon MO, Wilson B, Weinreb RN, Kass MA; Ocular Hypertension Treatment Study Group. Variability of intraocular pressure measurements in observation participants in the ocular hypertension treatment study. Ophthalmology 2009;116:717–724.

25. Chang JS, Lau SY. Correlation between axial length and anterior chamber depth in normal eyes, long eyes, and extremely long eyes. Asia Pac J Ophthalmol 2012;1:213– 215.

26. Tabuchi H, Kiuchi Y, Ohsugi H, Nakakura S, Han Z. Effects of corneal thickness and axial length on intraocular pressure and ocular pulse amplitude before and after cataract surgery. Can J Ophthalmol 2011;46:242–246.

27. Park CH, Kim JW. Effect of advanced glycation end products on oxidative stress and senescence of trabecular meshwork cells. Korean J Ophthalmol 2012;26:123–131.

28. Shepard AR, Millar JC, Pang IH, Jacobson N, Wang WH, Clark AF. Adenoviral gene transfer of active human transforming growth factor-{β}2 elevates intraocular pressure and reduces outflow facility in rodent eyes. Invest Ophthalmol Vis Sci 2010;51:2067–2076.

29. Hanyuda A, Sawada N, Yuki K, Uchino M, Ozawa Y, Sasaki M, et al. Relationships of diabetes and hyperglycaemia with intraocular pressure in a Japanese population: The JPHC-NEXT Eye Study. Sci Rep 2020;10:5355.

30. Bilak S, Simsek A, Capkin M, Guler M, Bilgin B. Biometric and intraocular pressure change after cataract surgery. Optom Vis Sci 2015;92:464–470.

31. Gunes A, Uzun F, Karaca EE, Kalaycι M. Evaluation of anterior segment parameters in obesity. Korean J Ophthalmol 2015;29:220–225.

32. Stojanov O, Stokić E, Sveljo O, Naumović N. The influence of retrobulbar adipose tissue volume upon intraocular pressure in obesity. Vojnosanit Pregl 2013;70:469–476.

33. Youngblood HA, Parker E, Cai J, Perkumas K, Yu H, Sun J, et al. Identification of estrogen signaling in a prioritization study of intraocular pressure-associated genes. Int J Mol Sci 2021;22:10288.

34. Vajaranant TS, Maki PM, Pasquale LR, Lee A, Kim H, Haan MN. Effects of hormone therapy on intraocular pressure: The Women’s Health Initiative-Sight Exam Study. Am J Ophthalmol 2016;165:115–124.

35. Banna HU, Zanabli A, McMillan B, Lehmann M, Gupta S, Gerbo M, et al. Evaluation of machine learning algorithms for trabeculectomy outcome prediction in patients with glaucoma. Sci Rep 2022;12:2473.

36. Yaskanich AH, Fang W, Elwarfalli I, Palko JR. Influence of ocular and systemic variables on intraocular pressure change following phacoemulsification in non-glaucomatous eyes. ARVO Annual Meeting 2023. New Orleans, LA; 2023.

37. Yaskanich AH, Fang W, Elwarfalli I, Palko JR. Influence of ocular and systemic variables on intraocular pressure change following phacoemulsification in nonglaucomatous eyes [Abstract Issue]. Invest Ophthalmol Vis Sci 2023;64:4250.