Clinical outcomes after lens extraction for visually significant cataract in eyes with primary angle closure

J Glaucoma. Oct-Nov 2012;21(8):545-50. doi: 10.1097/IJG.0b013e31821db1db.

Abstract

Purpose: To examine the clinical outcomes of cataract extraction in eyes with primary angle closure (PAC) and coexisting cataract.

Patients and methods: Retrospective study of surgical outcomes after phacoemulsification and intraocular lens implantation in 55 eyes of 39 patients with PAC or occludable angles and visually symptomatic cataract. Approximately, 61.8% of eyes had received a peripheral iridotomy and 65% had evidence of glaucomatous optic neuropathy (GON).

Results: At 7.2 months after cataract extraction, a statistically significant reduction in intraocular pressure (IOP) was observed in all eyes with PAC (median 3 mm Hg, P=<0.0001). The reduction in IOP was significantly greater in eyes with a higher preoperative IOP (P=<0.0001). On average, one less glaucoma medication was in use postoperatively (P=0.01). Eyes with >180 degrees of peripheral anterior synechiae (PAS) preoperatively achieved a significantly greater reduction in IOP postoperatively compared with those with less PAS (7.5 vs. 4.4 mm Hg, P=0.03). The observed reduction in IOP in eyes with PAC and GON was significantly greater compared with those without GON (5.6 vs. 2.5 mm Hg, P=0.01). Visual acuity was significantly improved after cataract extraction by a mean of -0.23 LogMAR units (P=0.0001).

Conclusions: Contrary to earlier expectations, the observed reduction in postoperative IOP in eyes with PAC was significantly greater in the presence of a higher preoperative IOP, a larger number of glaucoma medication, narrower iridotrabecular angle width, and greater extent of PAS formation and in eyes with evidence of GON. Lens extraction seems to have a beneficial effect on IOP control in PAC, and is especially efficacious in more advanced cases.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cataract / complications*
  • Cataract / physiopathology
  • Female
  • Glaucoma, Angle-Closure / complications*
  • Glaucoma, Angle-Closure / physiopathology
  • Humans
  • Intraocular Pressure / physiology*
  • Iridectomy
  • Iris / surgery
  • Lens Implantation, Intraocular*
  • Male
  • Middle Aged
  • Optic Nerve Diseases / complications
  • Optic Nerve Diseases / physiopathology
  • Phacoemulsification*
  • Pseudophakia / physiopathology*
  • Retrospective Studies
  • Tonometry, Ocular
  • Treatment Outcome
  • Visual Acuity / physiology