Outcomes of Filtering Surgery Versus Clear Lens Extraction in Young Patients With Angle-Closure Glaucoma

Abstract

PurposeTo compare the effect of filtering surgery versus clear lens extraction in young patients with medically uncontrolled angle-closure glaucoma (ACG). DesignRetrospective, non-randomized, comparative, interventional study. MethodsWe reviewed the medical charts of patients with the following scenarios: (1) age ≤ 40 years, (2) diagnosis of ACG without cataract, including primary angle-closure glaucoma (PACG), nanophthalmic ACG and ACG combined with retinal dystrophies, (3) ACG undergoing filtering surgery or clear lens extraction. The main outcomes including intraocular pressure (IOP), number of medications, best-corrected visual acuity, and severe complications were extracted at the postoperative early (within 1 week) and late stage (>3 months) follow-up. ResultsData from 160 eyes of 130 young patients with ACG were available. Eyes with 76 PACG, 12 nanophthalmic ACG, and 26 ACG with retinal diseases underwent filtering surgery, while eyes with 22 PACG, 12 nanophthalmic ACG, and 12 ACG with retinal diseases received clear lens extraction. Overall, filtering surgery and clear lens extraction resulted in significant but comparable IOP and drug reductions at the postoperative late stage in each ACG subgroup, with similar complete success rates between two treatments (all P >.05). Regarding the safety, filtering surgery and patients with retinal diseases were independent factors associated with postoperative malignant glaucoma (P <.05 in both multivariable logistic regression models). ConclusionsThis study highlights that the efficacy of clear lens extraction is comparable to that of filtering surgery in medically uncontrolled young ACG, but clear lens extraction is safer, especially for young ACG comorbid with retinal diseases.