Phacoemulsification and intraocular lens implantation for acute angle closure not treated or previously treated by laser iridotomy

Abstract

Phacoemulsification with IOL implantation lowered IOP, improved visual acuity, and diminished the need for antiglaucoma medication in eyes with acute angle closure and with a prior acute angle closure treated by laser iridotomy.

Combined phacoemulsification and viscogoniosynechialysis in the management of patients with chronic angle closure glaucoma

“…There have been several reports that cataract extraction in eyes with angle-closure glaucoma lowers the IOP [1,7,8,[12][13][14]. Cataract extraction in these patients increases the anterior chamber depth, and it is hoped that the angle will be less crowded if PASs have not already been formed.…”

“…Extracting a thick and anteriorly positioned lens that has an important role in causing angle closure significantly deepens the anterior chamber and widens the drainage angle [1,[6][7][8][9]. It has been shown that cataract surgery successfully lowers the IOP in patients with uncontrolled angle closure glaucoma and may have certain advantages over trabeculectomy [8][9][10].…”

“…It has been shown that cataract surgery successfully lowers the IOP in patients with uncontrolled angle closure glaucoma and may have certain advantages over trabeculectomy [8][9][10]. After cataract surgery, the trabecular meshwork will remain occluded by peripheral anterior synechia (PAS) despite anterior chamber deepening.…”

Role of Lens Extraction In Glaucoma – A Review

“…18,42 Summarizing the choice between lens extraction or trabeculectomy, Trikhaa et al based the decision on extent of glaucomatous damage, extent of PAS and residual angle closure, magnitude of IOP, dimensions of lens vault or lens thickness and refractive error especially hyperopia, with presence of latter influencing in favour of lens extraction. 43 However a Cochrane Database Systematic Review in 2006 opined that no evidence exists for effectiveness of lens extraction for chronic PACG based on non-existence of data from randomised control studies and presence of only two non-randomised comparative studies.…”

“…Few randomised control trials and case studies support the above with most patients not showing requirement of additional long term medications. 42,[47][48][49] Gunning & Greve in their study noted 45-55% IOP drop in patients with acute ACG and uncontrolled IOP subjected to lens extraction. 34 Lam et al in their study of 62 eyes, evaluated primary phacoemulsification versus LPI and documented an IOP increase from 16% at 3 month follow-up, to 47% at 18 month follow-up in LPI group compared to only 3.2% (one patient) in phacoemulsification group at all follow-up visits.…”