Evaluation of efficacy of lens extraction for intraocular pressure reduction in eyes with primary angle closure glaucoma and primary angle closure

Abstract

INTRODUCTION. The purpose of the study was to evaluate the intraocular pressure (IOP) lowering effect of lens removal in eyes with primary angle closure glaucoma (PACG) and primary angle closure (PAC). MATERIALS AND METHODS. This study was a retrospective analysis of 114 eyes of 97 patients (83 women, 14 men; mean age 69.9 years) with PACG and PAC treated with lens extraction. Outcome measures: age, gender, visual acuity, IOP reduction over time, preoperative and postoperative number of IOP-lowering medications, axial length, intraocular lens (IOL) power, requirement for additional anti-glaucoma operations, and complications. Patients were divided into three groups: 1) patients with PAC (22 eyes) with mean follow-up 12.2 months; 2) patients with PACG with a history of previous acute angle closure (AAC) (39 eyes) with mean follow-up 15.4 months; and 3) patients with PACG without a history of previous AAC (53 eyes), with mean follow-up 13.5 months. Laser iridotomy was performed in all treated eyes prior to the surgery. RESULTS. In the group with PAC mean IOP was reduced from 42.2 ± 15.4 mm Hg (mean ± SD) under 2.6 IOP-lowering medications to 20.2 ± 10.4 mm Hg under 1.1 IOP-lowering medications (mean IOP reduction 52.1%). In the group with PACG with a history of previous AAC mean IOP was reduced from 29.0 ± 15.7 mm Hg under 2.1 IOP-lowering medications to 17.0 ± 7.5 mm Hg under 0.7 IOP-lowering medications (mean IOP reduction 41.3%). In the group with PACG without a history of previous AAC (53 eyes) mean IOP was reduced from 22.8 ± 8.0 mm Hg under 1.75 IOP-lowering medications to 18.8 ± 7.4 mm Hg under 1.5 IOP-lowering medications (mean IOP reduction 17.5%). In all three groups statistically significant improvement of visual acuity as a result of surgery was observed. There were no statistically significant differences between the three groups with regard to AXL or IOL power. Intraoperative complications were noticed in eight cases, and postoperative complications were noticed in four cases. The number of anti-glaucoma medications was reduced, but 17 eyes needed additional anti-glaucoma procedures. CONCLUSIONS. Lens extraction in eyes with PACG and PAC resulted in significant IOP reduction in all groups. The most pronounced IOP reduction was achieved in the group with PAC, where lens extraction was performed up to 60 days from AAC. Visual acuity was significantly improved as a result of surgery in all three study groups.