Early versus Delayed Phacoemulsification and Intraocular Lens Implantation for Acute Primary Angle-Closure

Yun-Hsuan Lin; Cheng-Hsiu Wu; Shih-Ming Huang; Chen Hsieh; Henry Shen-Lih Chen; Wan-Chen Ku; Ming-Hui Sun; Wei-Wen Su

doi:10.1155/2020/8319570

Early versus Delayed Phacoemulsification and Intraocular Lens Implantation for Acute Primary Angle-Closure

J Ophthalmol. 2020 Mar 24:2020:8319570. doi: 10.1155/2020/8319570. eCollection 2020.

Authors

Yun-Hsuan Lin^{1

2

3}, Cheng-Hsiu Wu^{1

2}, Shih-Ming Huang^{2

4

5}, Chen Hsieh⁶, Henry Shen-Lih Chen^{2

6}, Wan-Chen Ku¹, Ming-Hui Sun^{2

6}, Wei-Wen Su^{2

6}

Affiliations

¹ Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung Branch, Taiwan.
² Chang Gung University College of Medicine, Taoyuan, Taiwan.
³ Department of Electro-Optical Engineering, National Taipei University of Technology, Taipei, Taiwan.
⁴ Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung Branch, Taiwan.
⁵ Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
⁶ Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.

Abstract

Purpose: To compare the effects of early phacoemulsification and intraocular lens implantation (phaco/IOL), delayed phaco/IOL after initial laser peripheral iridotomy (LPI), and conventional LPI alone in patients with acute primary angle-closure (PAC).

Methods: Patients with acute PAC were included in the study, and those with secondary glaucoma, prior ocular trauma, or other ocular diseases and those who had undergone ocular surgeries previously were excluded. Patients were categorized into three groups: Group A, which underwent primary phaco/IOL after acute PAC; Group B, which underwent LPI initially after acute PAC, followed by phaco/IOL within 6 months; and Group C, which underwent LPI alone. The IOP control success at 12 months as well as changes in ocular characteristics and the number of antiglaucoma medications used after the treatment among the groups were evaluated.

Results: Eighty-one eyes were included in the study: 24 eyes in Group A, 23 eyes in Group B, and 34 eyes in Group C. The linear mixed model analysis demonstrated considerable IOP control in Groups A and B. Visual acuity, anterior chamber depth (ACD), and angle width improved significantly in Groups A and B, but not in Group C. The number of antiglaucoma medications used was significantly higher in Group C than in Groups A and B.

Conclusions: Patients who underwent phaco/IOL had better IOP control, improved vision, deeper ACD, and wider angle and required less antiglaucoma medications than those who underwent LPI alone. Performing phaco/IOL weeks to months after the initial LPI did not appear to adversely affect outcomes compared with those of early phaco/IOL.