Effect of Phacoemulsification on Anterior Chamber Angle in Eyes with Medically Uncontrolled Filtered Primary Angle-Closure Glaucoma

Abstract

Purpose. To evaluate the effect of phacoemulsification and intraocular lens (IOLs) implantation in eyes with medically uncontrolled primary angle-closure glaucoma (PACG) previously treated with trabeculectomy and to quantify the anatomical changes in the anterior chamber angle by ultrasound biomicroscopy (UBM). Methods. Forty-four eyes of 37 consecutive patients with medically uncontrolled PACG coexisting cataracts with a surgical history of trabeculectomy were included in this study. Each patient underwent phacoemulsification and IOL implantation. Indentation gonioscopy and UBM were performed preoperatively and then again 3 months after surgery. The main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of antiglaucoma medications and anatomical changes in the anterior chamber angle. Results. The mean logarithm of the minimum angle of resolution BCVA significantly improved from 0.52 ± 0.30 preoperatively to 0.26 ± 0.23 postoperatively (p<0.001). The mean IOP significantly decreased from 24.33 ± 9.65 mmHg preoperatively to 18.04 ± 7.86 mmHg postoperatively (p<0.05). 001). The median number of antiglaucoma medications decreased from 2 preoperatively to 1 postoperatively (p<0.001). There was no significant difference in the extent of peripheral anterior synechia after the surgery (p>0.05). Some parameters, including anterior central chamber depth, angle opening distance at 500 μm, trabecular-iris angle, and scleral ciliary process angle, were significantly higher after than before surgery (p<0.001). However, the crystalline lens rise was significantly smaller following the surgery (p<0.001). Conclusions. Phacoemulsification and IOL implantation reduced the IOP and improved vision in eyes with medically uncontrolled filtered PACG. The mechanism underlying the outcomes observed following surgery might be related to the anterior chamber deepening, widened drainage angle, and improved aqueous fluid flow to the trabecular meshwork.

Comparison of changes in retinal nerve fiber layer thickness and intraocular pressure between glaucoma and non-glaucoma patients after phacoemulsification

“…They reported decrease IOP and improved vision in these patients. 15 Our study showed an initial increase and a later decease in IOP at one month in glaucomatous as well as non-glaucomatous eyes. However, Majstruk reported a modest decrease in IOP even at one year after surgery.…”

The Effect of Capsulorhexis Size On Changes In The Anterior Chamber Depth And Iridocorneal Angle In Post Phacoemulsification Patient With Intraocular Lens Implantation

“…Phacoemulsification can relieve pupillary occlusion and reduce the angle of crowding caused by the thickened, anteriorly located lens. Mechanical deepening of the anterior chamber with viscoelastic infusion and saline during phacoemulsification (Zuo et al, 2020).…”

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

“…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. In addition, late LE due to the formation of goniosynechia in the eyes that had previously undergone trabeculectomy59 or LPI in subsequent selective laser trabeculoplasty60 does not lead to a decrease in ITC. Moreover, early LE can prevent the development of a pathologic process in the trabecular meshwork as PACD progresses61 and the development of PACG 16,62.…”