Intraocular pressure reduction in a spectrum of angle closure disease following cataract extraction

Abstract

Purpose: The purpose is to study the effect of cataract extraction on intraocular pressure (IOP) in patients with angle closure disease (ACD). Methods: In this retrospective study, patients with ACD including medically uncontrolled and advanced primary angle closure glaucoma (PACG) who underwent only cataract surgery were included. The IOP trend was analyzed at postoperative day 1, day 7, 1 month, 3 months, 6 months, 1 year, and final follow-up along with requirement of antiglaucoma medication (AGM)/surgery. Results: A total of 110 eyes of 79 patients [primary angle closure suspect (PACS): 21, PAC: 34, PACG: 55 eyes] were analyzed. Of these patients, 31 eyes had advanced PACG and 20 eyes had medically uncontrolled glaucoma. Best-corrected visual acuity >6/12 was seen in 51 eyes at baseline and 87 eyes at final follow-up. After cataract surgery alone, there was significant reduction (median) in IOP [19.1 ± 18.00% (18.8) in PACS ( P < 0.01), 8.55 ± 17.9% (10) in PAC ( P = 0.04), 22.82 ± 15.45%(14.3) in PACG ( P < 0.01), 18.27 ± 15.99% (14.5) in advanced PACG ( P = 0.01) and 36.56 ± 14.58% (28.57) in medically uncontrolled glaucoma ( P < 0.01)] and AGM [51.85% (1) in PAC, 32.35% (2) in PACG, 17.71% (2) in advanced PACG, and 40.74% (1.5) in medically uncontrolled PACD] at median follow-up of 1, 2.5, 1, 1.3, and 1 year. Eleven PACG patients, who were on systemic medication preoperatively, were off systemic therapy at final follow-up, while six other PACG eyes (10.9%) required glaucoma surgery. Conclusion: Cataract surgery leads to significant drop in IOP across the spectrum of ACD with visually significant cataract. Cataract surgery may be considered initially for IOP control even in advanced or medically uncontrolled PACG followed by glaucoma surgery later if required.

Phacoemulsification versus Phacotrabeculectomy in Medically Controlled Primary Angle Closure Glaucoma with Cataract in an Indian Cohort: A randomized controlled trial

“…However, it can be managed effectively by prompt intervention and perioperative systemic aqueous suppressant therapy. The reported incidence of IOP spike post cataract surgery in PACG eyes ranges from 6 to 21% [17,[33][34][35][36][37]. In our study, prophylactic oral acetazolamide 250-500 mg was prescribed after the surgery for patients in the Phaco group but not for those who underwent PT.…”

Nasal trabeculo-ciliary angle and relative lens vault as predictors for intraocular pressure reduction following phacoemulsification

“…The same applies to cases of ACG where the precise amount of IOP reduction is variable. 27,28 This assists our hypothesis that there should be some factors in the angle or lens dimensions that could predict this amount to determine which patient would benefit from lens removal.…”

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

“…Our study included patients with controlled open angle glaucoma whereas, other recent studies have shown that phacoemulsification resulted in increase in anterior chamber depth and decrease in IOP in Primary angle closure and other spectrum of angle closure diseases. 11 , 12 …”

“…Our study included patients with controlled open angle glaucoma whereas, other recent studies have shown that phacoemulsification resulted in increase in anterior chamber depth and decrease in IOP in Primary angle closure and other spectrum of angle closure diseases. 11,12 Certain parameters which affect the decrease in IOP were studied by Lin C et al and iris thickness and lens vault were found to be associated with decrease in IOP. 13 When changes in anterior chamber angle which lead to decrease in IOP were compared between eyes with narrow angle and normal eyes, it was seen that these changes never reached the eyes of normal values.…”