British Journal of Ophthalmology
Published online February 16, 2018
Refractive outcomes for eyes with primary angle-closure glaucoma (PACG) that undergo lens extraction can be unpredictable because of anatomic features such as shallow anterior chamber depth, short axial length, and a thickened lens positioned anteriorly. In the EAGLE study (Effectiveness in Angle-closure Glaucoma of Lens Extraction), patients with PAC/PACG who were treated with clear lens extraction (CLE) had better quality of life and control of intraocular pressure than their counterparts who received laser peripheral iridotomy (PI).
In a subsequent report, Day et al. described the surgical details, visual outcomes, and postoperative refractive errors of EAGLE participants who received CLE. They concluded that CLE is appropriate for some patients with PAC or PACG, but they emphasized the importance of individualized treatment, as CLE may result in suboptimal refractive outcomes in some eyes.
In the original study, eligible patients were assigned randomly to receive CLE or PI. The CLE group underwent phacoemulsification and implantation of a monofocal intraocular lens (IOL) within 60 days of randomization. Synechiolysis was permitted in accordance with local practice.
In this subsequent review, the authors reported postoperative corrected distance visual acuity (CDVA) at 36 months for the CLE group (n = 208). Collected data included the IOL formula and predicted refraction. Laser biometry was used to estimate axial length and IOL power.
Mean baseline CDVA was 77.9 letters (± standard deviation [SD], 12.4) and did not change significantly by month 36 (mean CDVA, 79.9; SD, 10.9). Spherical equivalents were +1.7 D (SD, 2.3) preoperatively and +0.08 D (SD, 0.95) at 36 months.
Overall, by 3 years postoperatively, 59% of eyes were within ± 0.5 D of their predicted refraction, and 85% eyes were within ± 1.0 D of that goal. Axial length < 22 mm correlated with outcomes that varied by > 1 D from predictions.
Although the mean CDVA of patients who underwent clear lens extraction for PACG appeared stable in the ensuing 3 years, and refractive error improved, the predictability of refractive outcomes was less than optimal, the authors said.
The original article can be found here.