Lens removal appears beneficial in advanced primary angle closure

This retrospective review found that lens extraction seems to have a beneficial effect on IOP control in primary angle closure (PAC), especially in more advanced cases.

This study reflects the changing paradigm for managing PAC and PACG. Evidence is mounting that phacoemulsification alone is superior to combined cataract-glaucoma surgery in managing these conditions, even in acute occurrences and in relatively advanced glaucoma cases. However, because this study was retrospective, clinicians should interpret the findings with some caution.

The authors reviewed the surgical outcomes of phacoemulsification with IOL implantation in 39 patients (55 eyes) with PAC or occludable angles and visually symptomatic cataract. Approximately, 61.8 percent of eyes had received a peripheral iridotomy and 65 percent had evidence of glaucomatous optic neuropathy.

While all eyes experienced significant IOP reduction, eyes with higher preoperative IOP experienced the greatest reduction (P<0.0001). On average, one less glaucoma medication was required after surgery (P = 0.01). Patients on a higher number of glaucoma medications and those with narrower iridotrabecular angle width, more extensive peripheral anterior synechiae formation, and evidence of glaucomatous optic neuropathy also benefited more from cataract surgery.

The authors note that although 16 percent of the cases were technically nanophthalmic, there were no cases of postoperative uveal effusion syndrome. The earlier formation of a peripheral iridotomy does not seem to influence postoperative IOP. Therefore, these factors should not limit the use of lens extraction as a means of improving IOP control in early-stage PAC or PACG.

They conclude that these data can be used to support further prospective studies, as patients with significant or advanced PAC could be enrolled without ethical concern.