Abstract
Purpose To compare the effects of early phacoemulsification and intraocular lens implantation (phaco/IOL), delayed phaco/IOL after initial laser peripheral iridotomy (LPI), and conventional LPI alone in patients with acute primary angle-closure (PAC). Methods Patients with acute PAC were included in the study, and those with secondary glaucoma, prior ocular trauma, or other ocular diseases and those who had undergone ocular surgeries previously were excluded. Patients were categorized into three groups: Group A, which underwent primary phaco/IOL after acute PAC; Group B, which underwent LPI initially after acute PAC, followed by phaco/IOL within 6 months; and Group C, which underwent LPI alone. The IOP control success at 12 months as well as changes in ocular characteristics and the number of antiglaucoma medications used after the treatment among the groups were evaluated. Results Eighty-one eyes were included in the study: 24 eyes in Group A, 23 eyes in Group B, and 34 eyes in Group C. The linear mixed model analysis demonstrated considerable IOP control in Groups A and B. Visual acuity, anterior chamber depth (ACD), and angle width improved significantly in Groups A and B, but not in Group C. The number of antiglaucoma medications used was significantly higher in Group C than in Groups A and B. Conclusions Patients who underwent phaco/IOL had better IOP control, improved vision, deeper ACD, and wider angle and required less antiglaucoma medications than those who underwent LPI alone. Performing phaco/IOL weeks to months after the initial LPI did not appear to adversely affect outcomes compared with those of early phaco/IOL.
Highlights
Primary angle-closure (PAC) is a condition caused by appositional or synechial closure of the anterior chamber angle that leads to aqueous outflow obstruction and intraocular pressure (IOP) elevation
Phacoemulsification and intraocular lens implantation performed within days after acute PAC effectively controls IOP and prevents future attack [7, 8], this procedure is not widely accepted as an initial treatment for acute PAC because of surgical difficulty. e current study aimed to compare the effects of performing phaco/IOL early and weeks to months after initial laser peripheral iridotomy (LPI) and conventional LPI only on 12 months IOP control as well as changes in visual acuity (VA), spherical equivalent (SE), anterior chamber depth (ACD), angle width, axial length (AL), and number of glaucoma medications used in eyes with acute PAC
A linear mixed model was constructed to compare the longitudinal IOP changes after treatment among the three groups. e success of IOP control was compared using Fisher’s test. e Kaplan–Meier survival curve was plotted for complete success in IOP control among the three groups, and the log rank test was used for verification
Summary
To compare the effects of early phacoemulsification and intraocular lens implantation (phaco/IOL), delayed phaco/IOL after initial laser peripheral iridotomy (LPI), and conventional LPI alone in patients with acute primary angle-closure (PAC). Patients were categorized into three groups: Group A, which underwent primary phaco/IOL after acute PAC; Group B, which underwent LPI initially after acute PAC, followed by phaco/IOL within 6 months; and Group C, which underwent LPI alone. Anterior chamber depth (ACD), and angle width improved significantly in Groups A and B, but not in Group C. e number of antiglaucoma medications used was significantly higher in Group C than in Groups A and B. Patients who underwent phaco/IOL had better IOP control, improved vision, deeper ACD, and wider angle and required less antiglaucoma medications than those who underwent LPI alone. Performing phaco/IOL weeks to months after the initial LPI did not appear to adversely affect outcomes compared with those of early phaco/IOL
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