Safety and Efficacy of Rapid Primary Phacoemulsification on Acute Primary Angle Closure with and without Preoperative IOP-Lowering Medication

Abstract

This study aimed to investigate the safety and efficacy of rapid primary phacoemulsification in patients with acute primary angle closure (APAC) (n = 41), with or without preoperative IOP-lowering medication. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of corneal endothelial cells (CECs), and number of IOP-lowering medications at the preoperative examination (Pre), postoperative day 1 (1d), week 1 (1w), and month 1 (1m) were used as indicators and compared. BCVA significantly improved at 1d, 1w, and 1m compared with Pre (p < 0.05) and significantly improved at 1m compared to 1d (p < 0.05) for all eyes. IOP significantly decreased at 1d, 1w, and 1m compared with Pre (p < 0.05). CECs were not significantly different between Pre and 1m; the number of IOP-lowering medications decreased significantly from Pre to 1m (p < 0.05). BCVA and IOP were not significantly different between the two groups for all periods. CECs were not significantly different between the two groups at Pre and 1m. Rapid primary phacoemulsification improved visual acuity due to improvement of corneal edema without central visual field defects and good IOP control without reoperation or IOP-lowering medication and maintained the number of corneal endothelial cells with or without preoperative IOP-lowering medication in patients with APAC.

Refractive outcomes after immediate primary phacoemulsification for acute primary angle closure

“…As we previously reported 10 , primary phacoemulsification provides good postoperative IOP control. However, preoperative examination for selecting the appropriate IOL was performed very early, when IOP was still high, and AL was measured while still elongated.…”

“…Common treatments include medical therapy, such as miosis eye drops to remove the pupillary block, and intraocular pressure (IOP)-lowering eye drops, or intravenous infusion, followed by laser peripheral iridotomy (LPI) 1 – 5 or phacoemulsification to remove the pupillary block 6 – 9 . We have previously reported the course of immediate phacoemulsification as a primary treatment for APAC with or without preoperative IOP-lowering medication (glaucoma eye drops, oral medications, or intravenous infusion) 10 .…”

Malignant Glaucoma After Immediate Primary Phacoemulsification for Acute Primary Angle Closure: A Case Report

“…After IOL insertion, the angle was observed with a Mori goniotomy lens (RE Medical Inc., Osaka, Japan) (Figures 1B , 1C ). Peripheral anterior synechiae were observed at a superior angle from 11 o’clock to 1 o’clock, and goniosynechialysis (GSL) was performed with viscoelasticity only, as previously reported [ 9 ]. The angles in the other areas were open.…”

“…However, it can also occur after intraocular surgery [2][3][4][5][6], topical miotic therapy [7], or in eyes that have not previously undergone surgery [8]. We have reported the clinical outcomes of immediate primary phacoemulsification for acute primary angle closure (APAC) [9]. Other reports have also investigated the outcomes of primary phacoemulsification for APAC [10][11][12][13].…”