Predictors of long-term intraocular pressure control after lens extraction in primary angle closure glaucoma: results from the EAGLE trial

Abstract

Background/aimsTo assess baseline ocular parameters in the prediction of long-term intraocular pressure (IOP) control after clear lens extraction (CLE) or laser peripheral iridotomy (LPI) in patients with primary angle closure (PAC) disease using data from the Effectiveness of Early Lens Extraction for the treatment of primary angle-closure glaucoma (EAGLE) tria.MethodsThis study is a secondary analysis of EAGLE data where we define the primary outcome of ‘good responders’ as those with IOP<21 mm Hg without requiring additional surgery and ‘optimal responders’ as those who in addition were medication free, at 36-month follow-up. Primary analysis was conducted using a multivariate logistic regression model to assess how randomised interventions and ocular parameters predict treatment response.ResultsA total of 369 patients (182 in CLE arm and 187 in LPI arm) completed the 36-month follow-up examination. After CLE, 90% met our predefined ‘good response’ criterion compared with 67% in the LPI arm, and 66% met ‘optimal response’ criterion compared with 18% in the LPI arm, with significantly longer drops/surgery-free survival time (p<0.05 for all). Patients randomised to CLE (OR=10.1 (6.1 to 16.8)), Chinese (OR=2.3 (1.3 to 3.9)), and those who had not previously used glaucoma drops (OR=2.8 (1.6 to 4.8)) were more likely to maintain long-term optimal IOP response over 36 months.ConclusionPatients with primary angle closure glaucoma/PAC are 10 times more likely to maintain drop-free good IOP control with initial CLE surgery than LPI. Non-Chinese ethnicity, higher baseline IOP and using glaucoma drops prior to randomisation are predictors of worse long-term IOP response.

Association of Gonioscopy Scores with Changes in Intraocular Pressure after Phacoemulsification in a Predominantly Vietnamese Population: A Retrospective Study

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Association of Gonioscopy Scores with Changes in Intraocular Pressure after Phacoemulsification in a Predominantly Vietnamese Population: A Retrospective Study

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The Effects of Lens Extraction Surgery on Intraocular Pressure and Anterior Segment Parameters in Primary Angle-Closure Glaucoma

“…The long-term results of the EAGLE study also indicated that patients with PACG who undergo CLE have a 10-fold higher rate of achieving IOP control without using antiglaucoma eye drops compared to the group that underwent LPI. 9 In the present study, the PACG group had a mean preoperative IOP of 20.1 mmHg and used an average of 2.9 medications, which decreased to 15.1 mmHg and 1.7 medications after surgery. The decrease in IOP was significantly greater in the PACG group compared to the control group.…”

“…The long-term results of the EAGLE study also support the initial findings. 9 This study demonstrated the potential benefit of performing early lens surgery in eyes where the lens is a significant component of angle closure, without waiting for the development of cataract. 2 , 9 However, these patients were over 50 years old, with lost accommodative ability and without significant advanced glaucoma.…”

“… 9 This study demonstrated the potential benefit of performing early lens surgery in eyes where the lens is a significant component of angle closure, without waiting for the development of cataract. 2 , 9 However, these patients were over 50 years old, with lost accommodative ability and without significant advanced glaucoma. It should be noted that young individuals may experience accommodative loss following CLE.…”

Phacoemulsification versus Laser Peripheral Iridotomy for Treating Primary Angle Closure Glaucoma: A Systematic Review and Meta-Analysis

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Association of Gonioscopy Scores with Changes in Intraocular Pressure after Phacoemulsification in a Predominantly Vietnamese Population: A Retrospective Study

“……”

The Effects of Lens Extraction Surgery on Intraocular Pressure and Anterior Segment Parameters in Primary Angle-Closure Glaucoma

“…The long-term results of the EAGLE study also indicated that patients with PACG who undergo CLE have a 10-fold higher rate of achieving IOP control without using antiglaucoma eye drops compared to the group that underwent LPI. 9 In the present study, the PACG group had a mean preoperative IOP of 20.1 mmHg and used an average of 2.9 medications, which decreased to 15.1 mmHg and 1.7 medications after surgery. The decrease in IOP was significantly greater in the PACG group compared to the control group.…”

“…The long-term results of the EAGLE study also support the initial findings. 9 This study demonstrated the potential benefit of performing early lens surgery in eyes where the lens is a significant component of angle closure, without waiting for the development of cataract. 2 , 9 However, these patients were over 50 years old, with lost accommodative ability and without significant advanced glaucoma.…”

“… 9 This study demonstrated the potential benefit of performing early lens surgery in eyes where the lens is a significant component of angle closure, without waiting for the development of cataract. 2 , 9 However, these patients were over 50 years old, with lost accommodative ability and without significant advanced glaucoma. It should be noted that young individuals may experience accommodative loss following CLE.…”

Phacoemulsification versus Laser Peripheral Iridotomy for Treating Primary Angle Closure Glaucoma: A Systematic Review and Meta-Analysis

“……”

Association of Gonioscopy Scores with Changes in Intraocular Pressure after Phacoemulsification in a Predominantly Vietnamese Population: A Retrospective Study

“……”

The Effects of Lens Extraction Surgery on Intraocular Pressure and Anterior Segment Parameters in Primary Angle-Closure Glaucoma

“…The long-term results of the EAGLE study also indicated that patients with PACG who undergo CLE have a 10-fold higher rate of achieving IOP control without using antiglaucoma eye drops compared to the group that underwent LPI. 9 In the present study, the PACG group had a mean preoperative IOP of 20.1 mmHg and used an average of 2.9 medications, which decreased to 15.1 mmHg and 1.7 medications after surgery. The decrease in IOP was significantly greater in the PACG group compared to the control group.…”

“…The long-term results of the EAGLE study also support the initial findings. 9 This study demonstrated the potential benefit of performing early lens surgery in eyes where the lens is a significant component of angle closure, without waiting for the development of cataract. 2 , 9 However, these patients were over 50 years old, with lost accommodative ability and without significant advanced glaucoma.…”

“… 9 This study demonstrated the potential benefit of performing early lens surgery in eyes where the lens is a significant component of angle closure, without waiting for the development of cataract. 2 , 9 However, these patients were over 50 years old, with lost accommodative ability and without significant advanced glaucoma. It should be noted that young individuals may experience accommodative loss following CLE.…”

Phacoemulsification versus Laser Peripheral Iridotomy for Treating Primary Angle Closure Glaucoma: A Systematic Review and Meta-Analysis

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