Clinical Outcomes After Lens Extraction for Visually Significant Cataract in Eyes With Primary Angle Closure

Abstract

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