Abstract
PurposeTo evaluate the changes in anterior chamber angle (ACA) parameters in primary angle closure (PAC) spectrum eyes before and after cataract extraction (CE) and compare to the changes after laser peripheral iridotomy (LPI) using anterior segment optical coherence tomography (ASOCT).MethodsTwenty-eight PAC spectrum eyes of 18 participants who underwent CE and 34 PAC spectrum eyes of 21 participants who underwent LPI were included. ASOCT images with 3-dimensional mode angle analysis scans were taken with the CASIA SS-1000 (Tomey Corp., Nagoya, Japan) before and after CE or LPI. Mixed-effect model analysis was used to 1) compare best-corrected visual acuity, intraocular pressure, and ACA parameters before and after CE; 2) identify and estimate the effects of potential contributing factors affecting changes in ACA parameters; and 3) compare CE and LPI treatment groups.ResultsThe increase in average angle parameters (TISA750 and TICV750) was significantly greater after CE than LPI. TICV750 increased by 102% (2.114 [±1.203] μL) after LPI and by 174% (4.546 [± 1.582] μL) after CE (P < 0.001). Change of TICV750 in the CE group was significantly affected by age (P = 0.002), race (P = 0.006), and intraocular lens power (P = 0.037).ConclusionsCE results in greater anatomic changes in the ACA than LPI in PAC spectrum eyes. ASOCT may be used to follow anatomic changes in the angle after intervention.
Highlights
Primary angle closure glaucoma (PACG) is a leading cause of irreversible bilateral blindness worldwide
cataract extraction (CE) results in greater anatomic changes in the anterior chamber angle (ACA) than Laser peripheral iridotomy (LPI) in primary angle closure (PAC) spectrum eyes
Our study demonstrated significant increases in ACA parameters, including TISA500, TISA750, TICV500, TICV750, and extent of irido-trabecular contact (ITC), after CE in participants with concomitant PAC spectrum disease
Summary
Primary angle closure glaucoma (PACG) is a leading cause of irreversible bilateral blindness worldwide. Because the anterior chamber anatomy is a predisposing condition in the PAC spectrum, a surgical treatment to deepen the peripheral anterior chamber angle (ACA) for these eyes may prevent progression of the disease. Laser peripheral iridotomy (LPI) is traditionally the primary mono-surgical therapy for PAC spectrum eyes [4]. Several studies have shown that the ACA in PAC spectrum eyes is significantly deepened after LPI [5,6,7]. While an LPI may be sufficient to prevent progression of PAC, several studies have shown that > 50% of PAC spectrum patients require further therapy for angle closure, despite anatomical angle deepening [3, 8]
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