Prediction of IOP Reduction after Cataract Surgery in Medically Treated Normal-Tension Glaucoma: A Nomogram Study in South Korea

This study evaluated the intraocular pressure (IOP)–lowering effect of cataract surgery in patients with normal-tension glaucoma (NTG) under stable medical therapy. We also developed a predictive tool to identify individuals likely to achieve clinically meaningful IOP reduction. In a retrospective review of 292 eyes that underwent cataract surgery between January 2019 and February 2024, we assessed IOP changes and anterior chamber angle parameters over a 6-month period. Eyes without glaucoma showed a significant reduction in IOP, whereas those with NTG exhibited no overall significant change, with considerable inter-individual variability. Multivariable analysis indicated that higher preoperative IOP, narrower anterior chamber angles, shallower anterior chamber depth (ACD), and older age were associated with an increased likelihood of achieving a ≥ 10% IOP reduction after cataract surgery. These factors were incorporated into a nomogram that demonstrated good predictive performance and calibration. Our findings suggest that cataract surgery may provide IOP-lowering benefits in selected NTG patients with favorable preoperative anatomical profiles, and the proposed nomogram offers a practical approach for personalized surgical planning and risk stratification.