Abstract
Purpose To evaluate the effect of phacoemulsification and intraocular lens (IOLs) implantation in eyes with medically uncontrolled primary angle-closure glaucoma (PACG) previously treated with trabeculectomy and to quantify the anatomical changes in the anterior chamber angle by ultrasound biomicroscopy (UBM). Methods Forty-four eyes of 37 consecutive patients with medically uncontrolled PACG coexisting cataracts with a surgical history of trabeculectomy were included in this study. Each patient underwent phacoemulsification and IOL implantation. Indentation gonioscopy and UBM were performed preoperatively and then again 3 months after surgery. The main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of antiglaucoma medications and anatomical changes in the anterior chamber angle. Results The mean logarithm of the minimum angle of resolution BCVA significantly improved from 0.52 ± 0.30 preoperatively to 0.26 ± 0.23 postoperatively (p < 0.001). The mean IOP significantly decreased from 24.33 ± 9.65 mmHg preoperatively to 18.04 ± 7.86 mmHg postoperatively (p < 0.05). 001). The median number of antiglaucoma medications decreased from 2 preoperatively to 1 postoperatively (p < 0.001). There was no significant difference in the extent of peripheral anterior synechia after the surgery (p > 0.05). Some parameters, including anterior central chamber depth, angle opening distance at 500 μm, trabecular-iris angle, and scleral ciliary process angle, were significantly higher after than before surgery (p < 0.001). However, the crystalline lens rise was significantly smaller following the surgery (p < 0.001). Conclusions Phacoemulsification and IOL implantation reduced the IOP and improved vision in eyes with medically uncontrolled filtered PACG. The mechanism underlying the outcomes observed following surgery might be related to the anterior chamber deepening, widened drainage angle, and improved aqueous fluid flow to the trabecular meshwork.
Highlights
Glaucoma is the leading cause of irreversible blindness worldwide [1]
Few studies have evaluated the effect of phacoemulsification on anterior chamber angle in eyes with medically uncontrolled Primary angle-closure glaucoma (PACG) previously treated with trabeculectomy
E mean LogMAR best-corrected visual acuity (BCVA) improved significantly from 0.52 ± 0.30 preoperatively to 0.26 ± 0.23 postoperatively (p < 0.001). e mean intraocular pressure (IOP) decreased significantly from 24.33 ± 9.65 mmHg to 18.04 ± 7.86 mmHg (p < 0.001). e median number of medications decreased from 2 preoperatively to 1 postoperatively (p < 0.001). ere was no significant difference in the extent of Peripheral anterior synechia (PAS) between before and after the surgery (p 0.714) (Table 2)
Summary
Glaucoma is the leading cause of irreversible blindness worldwide [1]. Primary angle-closure glaucoma (PACG) is an important type of glaucoma that has a high prevalence in Asia and is a large burden in China [2]. Trabeculectomy is a classic treatment for PACG, but traditional trabeculectomy is associated with a high risk of postoperative complications, such as malignant glaucoma, bleb-related infections, and surgical failure [3]. Trabeculectomy can increase the risk of cataract formation and progression [4]. E treatment of medically uncontrolled PACG after initial trabeculectomy is more complicated. Cataract surgery, even clear lens extraction, has become a first-line therapy for PACG. Numerous studies have shown that phacoemulsification and intraocular lens (IOL) implantation can increase the anterior chamber depth (ACD), open the irido-corneal angle, and decrease the intraocular pressure (IOP) [5,6,7,8]. Few studies have evaluated the effect of phacoemulsification on anterior chamber angle in eyes with medically uncontrolled PACG previously treated with trabeculectomy
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