Surgical choice and effect in patients with acute angle-closure glaucoma secondary to subluxated lens

Abstract

Objective To retrospectively evaluate the surgical procedures and results for eyes with acute angle-closure glaucoma secondary to lens subluxation. Methods Thirty-six cases (41 eyes) with acute angle-closure glaucoma secondary to lens subluxation were examined by gonioscopy and/or ultrasound biomicroscopy (UBM). The different surgical procedures such as phacoemulsification with capsular tension ring lens (CTR) and intraocular lens (IOL) implantation, extracapsular cataract extraction (ECCE) and/or antiglaucoma surgery were chosen according to the extent of anterior chamber angle close and lens subluxation. Visual outcome and intraocular pressure (IOP) were examined on postoperative days 1, 7 and 30. Results The best corrected visual acuity (BCVA) was significantly improved and IOP was well controlled in all eyes during the follow-up. The BCVA was better than 0.5 in 17 eyes (41.46%), in 24 eyes (58.54%) and in 27 eyes (65.85%) on postoperative day 1, 7 and 30, respectively. IOP was less than 21 mmHg in 30 eyes (73.17%), in 35 eyes (85.36%) and in all eyes (100%) on postoperative day 1, 7 and 30, respectively. Conclusions It is safe and effective to choose phacoemulsification combined with CTR and IOL implantation for eyes with zonular defect less than 2 quadrants, ECCE and IOL implantation for eyes with zonular defects more than 2 quadrants and lens extraction combined with trabeculectomy for eyes with anterior chamber angle close more than half of the angle. Key words: Lens subluxation; Acute angle-closure glaucoma; Phacoemulsification; Capsular tension ring; Trabeculectomy