Early versus Delayed Phacoemulsification and Intraocular Lens Implantation for Acute Primary Angle-Closure

Abstract

Purpose. To compare the effects of early phacoemulsification and intraocular lens implantation (phaco/IOL), delayed phaco/IOL after initial laser peripheral iridotomy (LPI), and conventional LPI alone in patients with acute primary angle-closure (PAC). Methods. Patients with acute PAC were included in the study, and those with secondary glaucoma, prior ocular trauma, or other ocular diseases and those who had undergone ocular surgeries previously were excluded. Patients were categorized into three groups: Group A, which underwent primary phaco/IOL after acute PAC; Group B, which underwent LPI initially after acute PAC, followed by phaco/IOL within 6 months; and Group C, which underwent LPI alone. The IOP control success at 12 months as well as changes in ocular characteristics and the number of antiglaucoma medications used after the treatment among the groups were evaluated. Results. Eighty-one eyes were included in the study: 24 eyes in Group A, 23 eyes in Group B, and 34 eyes in Group C. The linear mixed model analysis demonstrated considerable IOP control in Groups A and B. Visual acuity, anterior chamber depth (ACD), and angle width improved significantly in Groups A and B, but not in Group C. The number of antiglaucoma medications used was significantly higher in Group C than in Groups A and B. Conclusions. Patients who underwent phaco/IOL had better IOP control, improved vision, deeper ACD, and wider angle and required less antiglaucoma medications than those who underwent LPI alone. Performing phaco/IOL weeks to months after the initial LPI did not appear to adversely affect outcomes compared with those of early phaco/IOL.

Comparison of Laser Iridotomy and Lensectomy Outcomes for Acute Primary Angle Closure

“…Most previous studies are merely focused on the visual prognosis of lensectomy. Since the treatment option, the sample size, the follow-up period, the study design, and the outcome measures are individually different among these previous and current studies, we cannot directly compare the treatment outcomes of APAC, but visual outcomes in the present study were slightly better than, and the IOP and the ECD were almost equivalent to, those in previous studies, as shown in Table 3 [ 2 , 4 , 5 , 8 – 10 , 15 ] Lam et al demonstrated that lensectomy was superior to LI in terms of reducing the IOP rise [ 1 ] Aung T et al showed that the majority of eyes developing IOP rise after LI for APAC occurred within 6 months from the onset [ 16 ].…”

Angle, anterior chamber parameters, and intraocular pressure changes after early phacoemulsification in acute angle-closure glaucoma

“…18,29 A recent study encouraged phacoemulsification after AACG to enhance VA and control IOP, although the cataract operation was risky. 4,30…”

Comparison of Lens Extraction Versus Laser Iridotomy on Anterior Segment, Choroid, and Intraocular Pressure in Primary Angle Closure Using Machine Learning

“…It is known that LE in PACG, compared with combined lensectomy and trabeculectomy, is more effective in terms of the ACA opening and allows maintaining the result for at least 6 months after the treatment 55. There are many studies devoted to the advantages of LE over LPI in acute primary closed angle 56,57. The insufficiency of LPI for the treatment of acute primary closed angle is proven by the fact that 30% of patients subsequently require trabeculectomy due to IOP decompensation 58.…”