Coexistent Cataract Research Articles

The Clinical Outcomes of Cataract Extraction by Phacoemulsification in Eyes With Primary Angle-Closure Glaucoma (PACG) and Co-existing Cataract: A Prospective Case Series

The Clinical Outcomes of Cataract Extraction by Phacoemulsification in Eyes With Primary Angle-Closure Glaucoma (PACG) and Co-existing Cataract: A Prospective Case Series

The Clinical Outcomes of Cataract Extraction by Phacoemulsification in Eyes With Primary Angle-Closure Glaucoma (PACG) and Co-existing Cataract: A Prospective Case Series

Lai, Jimmy S. M. MD, FRCOphth* †; Tham, Clement C. Y. FRCS FCOphth(HK)* §; Chan, Jonathan C. H. MRCSEd* † Author Information

The Clinical Outcomes of Cataract Extraction by Phacoemulsification in Eyes With Primary Angle-Closure Glaucoma (PACG) and Co-Existing Cataract

PURPOSE To evaluate the clinical outcomes of minimally invasive cataract extraction by phacoemulsification, with primary intraocular lens implantation, in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract. MATERIALS AND METHODS Consecutive primary angle-closure glaucoma patients with co-existing visually significant cataract were invited to participate in this prospective study. After obtaining informed consent, cataract extraction by phacoemulsification through a clear corneal incision was performed under topical anesthesia. Foldable intraocular lenses were implanted in the same setting. These patients were then followed up for a minimum of 1 year. Outcome measures included intraocular pressure (IOP), requirement for glaucoma drugs, and visual acuity. RESULTS Twenty-one primary angle-closure glaucoma eyes of 21 patients were recruited. Mean age (+/- SD) was 73.7 +/- 8.1 years (range, 60-87 years). There were 12 female patients and 9 male patients, with 13 right eyes and 8 left eyes. Nine eyes (42.9%) had history of acute primary angle closure. Mean follow-up duration was 20.7 +/- 3.6 months (range, 13-26 months). Intraocular pressure was decreased from a mean preoperative level of 19.7 +/- 6.1 mm Hg (range, 11 mm Hg-40 mm Hg) to 15.5 +/- 3.9 mm Hg (range, 9 mm Hg-26 mm Hg) at final follow-up (P = 0.022) (paired t test). The number of glaucoma eye drops required was decreased from a mean preoperative level of 1.91 +/- 0.77 (range, 1-3) to 0.52 +/- 0.87 (range, 0-3) at final follow-up (P < 0.001) (paired t test). In 10 eyes (47.6%), visual acuity improved significantly after surgery. In 9 eyes (42.9%), visual acuity remained the same. In 2 eyes (9.5%), visual acuity deteriorated significantly after surgery. Mean cup-to-disc ratio was 0.6 +/- 0.2 (range, 0.3-0.9) preoperatively, and 0.7 +/- 0.2 (range, 0.3-0.9) postoperatively (P = 0.047) (paired t test). CONCLUSIONS In primary angle-closure glaucoma patients with co-existing cataract, cataract extraction alone (by phacoemulsification) can significantly reduce both intraocular pressure and the requirement for glaucoma drugs.

Surgical outcome of phacoemulsification combined with the Pearce trabeculectomy in patients with glaucoma

The safety and efficacy of phacoemulsification and posterior chamber lens insertion combined with the Pearce trabeculectomy (PE/PCL/P-TRX) in patients with coexistent cataract and glaucoma was evaluated retrospectively. The Pearce trabeculectomy is a form of nonfiltration glaucoma surgery in which an inner block containing trabecular meshwork is excised under a scleral-pocket incision which is closed tightly. Thirty consecutive eyes sustained a reduction of mean intraocular pressure from 21.0 ± 4.4 mm Hg to 16.6 ± 3.3 mm Hg after PE/PCL/P-TRX at one year (P < .001). The average number of glaucoma medications used was reduced from 1.9 to 0.8 postoperatively. At one year, 60% (18 of 30) of eyes treated with PE/PCL/P-TRX had intraocular pressures less than 21 mm Hg without medications.

Simultaneous surgical management of cataract and glaucoma.

This paper reports and analyses 70 combined cataract and trabeculectomy operations carried out on 50 patients by the two authors from 1973 to mid 1979. Control of glaucoma was achieved by surgery alone in 86%, the remaining 14% required additional medical therapy to achieve control. This therapy was less than that used preoperatively. Where the preoperative control was good 96% achieved post operative control without therapy. In eyes with poor preoperative control, 80% achieved post operative control without therapy. The complication rate was low and no eyes were lost in the series. The literature for alternatives for managing cataracts and glaucoma has been reviewed and analysis of this shows the following percentage control by surgery without additional medical therapy. (a) Cataract extraction alone 40.5%. (b) Drainage procedure followed by lens extraction 65.5%. (c) Combined cataract and glaucoma surgery other than trabeculectomy 79%. (d) Combined cataract and trabeculectomy 91%. The latter combined procedure is recommended for all eyes with coexistent cataract and glaucoma.