• Clear Lens Extraction for PACG in EAGLE

    By Lynda Seminara
    Selected By: Deepak P. Edward, MD

    Journal Highlights

    British Journal of Ophthalmology
    Published online February 16, 2018

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    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.