Phacoemulsification In Primary Angle-closure Glaucoma Research Articles

Canaloplasty and Trabeculotomy Combined With Phacoemulsification for Primary Angle-Closure Glaucoma: A Single-Surgeon Case Series.

To evaluate the outcomes of combined canaloplasty and trabeculotomy with phacoemulsification for primary angle-closure glaucoma (PACG). In this retrospective,consecutive, single-surgeon case series, we analyzed the pre- and postoperative measurements of PACG patients who had the procedure. Adverse events were recorded. The main outcomes were mean intraocular pressure (IOP) in each quartile of the follow-up yearand the number of IOP-lowering medications the patients were on by the end of each quartile compared to their baseline values. A total of 46 eyes from 39 PACG patients were included. The preoperative IOP and glaucoma medications taken were 19.33±6.03 mm Hg and 1.80±1.39, respectively (N=46). Postoperative IOP means (mm Hg) in the subsequent four quartiles were 14.00±3.33 (N=44), 13.44±2.83 (N=32), 14.38±2.39 (N=16), and 14.92±2.90 (N=13) (p<0.0001). The mean number of meds was 0.32±0.80, 0.22±0.42, 0.59±0.80, and 0.08±0.28 in each respective quartile (p<0.0001), while the median was 0 across all quartiles. Combining the OMNI surgical system with phacoemulsification led to substantial reductions in mean IOP and the number of IOP-lowering medications when compared to baseline measurements.

Cyclophotocoagulation under Microscopy Combined with Phacoemulsification for Primary Angle-Closure Glaucoma.

The purpose of this study was to evaluate the safety and efficacy of cyclophotocoagulation under microscopy combined with phacoemulsification in patients with primary chronic angle-closure glaucoma. We retrospectively reviewed the results of cyclophotocoagulation under microscopic direct vision combined with phacoemulsification in 35 eyes (35 patients) with primary chronic angle-closure glaucoma and coexisting visually significant cataracts, treated between January 2017 and April 2020 at the glaucoma unit of the affiliated Changshu Hospital of Xuzhou Medical University. All patients were followed up for at least 12 months postoperatively. The preoperative to postoperative changes in best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of antiglaucoma medications, and surgery-associated complications were recorded. The BCVA improved from 1.15 ± 0.91 logMAR preoperatively to 0.86 ± 0.82 logMAR at the final postoperative examination (Z = −3.62, P < 0.0001). The mean IOP was 36.63 ± 13.50 mmHg preoperatively and 15.14 ± 3.19 mmHg at the final examination (Z = −5.16, P < 0.0001). The number of antiglaucoma drugs was significantly reduced from 2.23 ± 0.55 preoperatively to 0.54 ± 0.86 at the final postoperative examination (Z = −5.26, P < 0.0001). The absolute value of the mean defect and retinal nerve fiber layer thickness at the last follow-up postoperatively were significantly reduced compared to preoperative values (Z = −3.35, P=0.001; Z = −4.56, P < 0.001, respectively). One patient experienced an explosive suprachoroidal hemorrhage during the operation. The sclera was incised at the corresponding site of the intraoperative hemorrhage. The operation was continued once there was no active bleeding, and the outcome was satisfactory. None of the patients required additional surgery to treat complications. Thus, cyclophotocoagulation under microscopic direct vision combined with phacoemulsification can be performed safely for the management of primary angle-closure glaucoma.

Safety and efficacy of incisional goniotomy as an adjunct with phacoemulsification in primary angle-closure glaucoma.

To evaluate the intraocular pressure (IOP)-lowering efficacy and safety of incisional goniotomy as an adjunct to phacoemulsification in primary angle-closure glaucoma (PACG) patients. Consecutive patients with PACG (high or borderline IOP) deemed fit for phacoemulsification were enrolled. After phacoemulsification, incisional goniotomy was performed with or without goniosynechialysis. Patient demographic profile, clinical data, and adverse events, if any, were analyzed during at least a 6-month follow-up period. Success was defined as IOP of 18 mm Hg or lesser with or without medications. Tertiary care Ophthalmic hospital. Prospective interventional case series. Of 46 eyes (38 patients) included, 69.6% eyes were classified as having advanced glaucoma. The mean treated IOP decreased by 7.3 ± 1.0 (SE) mm Hg (95% CI, 5.2-9.3) from 21.4 ± 6.6 to 14.2 ± 3.7 mm Hg at a mean duration of 11.7 ± 5.5 months (6-22 months) postoperatively (P < .001, paired t test). There was 66.6% reduction in median number of hypotensive medications (P < .001, Wilcoxon signed-rank test). Observed complications included hyphema (13 eyes [28%]), IOP spike (3 eyes [6.5%]), and cyclodialysis (1 eye [2.17%]). High treated IOP and number of medications were significantly associated with failure in univariate analysis (P < .05, Fisher exact test). The cumulative survival probability for qualified success at 22 months was 87.8% ± 0.07 (95% CI, 0.65-0.96). Incisional goniotomy as an adjunct with phacoemulsification resulted in a significant and sustained reduction in IOP along with decrease in number of glaucoma medications in chronic PACG eyes, irrespective of the disease stage.

Prospective Study on Ex-PRESS Implantation Combined with Phacoemulsification in Primary Angle-Closure Glaucoma Coexisting Cataract: 3-Year Results

ABSTRACTPurpose: To evaluate the feasibility, efficacy, and safety of Ex-PRESS implantation combined with phacoemulsification surgery in primary angle-closure glaucoma (PACG) with cataract.Materials and methods: This is a prospective, nonrandomized study. A total of 34 eyes of 34 subjects were enrolled. The assessments were conducted preoperatively and postoperatively at 1 week and 1, 3, 6, 12, 18, 24, 30, and 36 months. The assessments included intraocular pressure (IOP), best-corrected visual acuity (BCVA), the number of glaucoma medications, corneal endothelial cell density (ECD), and related complications, if any. The anterior segment structure was also assessed by anterior segment optical coherence tomography based on the anterior chamber depth (ACD), angle opening distance (AOD500), and trabecular-iris angle (TIA). A complete success was defined as a controlled IOP between 5 and 21 mmHg without medications.Results: The complete success rates at 12, 24, and 36 postoperative months were 91.2%, 81.7%, and 78.3%, respectively. The mean preoperative IOP was 28.43 ± 12.93 mmHg and decreased to 15.35 ± 4.02 mmHg at 3 years postoperatively (P < 0.001). The number of medications decreased from 2.47 ± 1.89 at baseline to 0.28 ± 0.76 at 3 years postoperatively (P = 0.001). BCVA was 0.83 ± 0.58 at baseline and 0.51 ± 0.33 at 3 years postoperatively (P = 0.008). The ACD, AOD500, and TIA significantly increased at 3 months postoperatively compared with baseline (P < 0.001). ECD at 3 months and 3 years postoperatively were both significantly lower compared with baseline (P = 0.03), but was not significantly different between 3 months and 3 years postoperatively (P = 0.07). The device-related complications identified were hypotony (5.8%), hyphema (2.9%), and iris touch (2.9%), which the incidence rates were all very low.Conclusions: Ex-PRESS implantation combined with phacoemulsification was effective for lowering IOP in PACG coexisting with cataract. The device-related complication was rare.

Evaluation of Ex-PRESS implantation combined with phacoemulsification in primary angle-closure glaucoma.

To evaluate the safety and efficacy of Ex-PRESS (R50) implantation combined with phacoemulsification in primary angle-closure glaucoma (PACG) patients with cataract.Twenty-four eyes of 24 patients with unregulated PACG underwent combined cataract and glaucoma surgery. After phacoemulsification and intraocular lens implantation, the Ex-PRESS (R-50) was inserted into the anterior chamber under a scleral flap. The intraocular pressure (IOP), best corrected visual acuity (BCVA), number of medications, and complications were recorded preoperatively as well as postoperatively on day 7 and at 1, 3, 6, and 12 months.The mean follow-up was 16.4 ± 2.5 months (range 14–21 months) and the mean age of the patients was 64.7 ± 6.8 years (range 56–78 years). The mean IOP was 20.4 ± 5.4 mm Hg preoperatively and decreased to 10.2 ± 2.8, 13.1 ± 2.7, 14.9 ± 4.1, 14.3 ± 3.9, and 14.0 ± 3.6 mm Hg on day 7 and at 1, 3, 6, and 12 months after surgery (all P < 0.005). At 12 months, the mean BCVA was 0.62 ± 0.33 and the number of medications was 0.3 ± 0.6. Most of complications were resolved spontaneously and conservatively.The Ex-PRESS implantation combined with phacoemulsification cataract extraction is safe and effective for reducing IOP and antiglaucoma medications in PACG patients with cataract.

Lowering of Intraocular Pressure After Phacoemulsification in Primary Open-Angle and Angle-Closure Glaucoma: A Bayesian Analysis.

Phacoemulsification as treatment for primary open-angle glaucoma (POAG) remains more controversial than for primary angle-closure glaucoma (PACG). If the objective of glaucoma surgery is an additional greater than or equal to 5 to 6 mm Hg reduction of intraocular pressure (IOP), the role of phacoemulsification should be based on the probability of achieving this. A Bayesian analysis of available data was performed to calculate the change in IOP after phacoemulsification in POAG and PACG. Standard meta-analysis formulation with prephacoemulsification and postphacoemulsification IOP-assumed to have normal distributions, with study-specific means and SDs-was used. Absolute and relative change in IOP was calculated using different priors, and sensitivity analyses were performed. The prior that just included a decrease of greater than or equal to 6 mm Hg in the 95% credible interval was identified. The probability of achieving greater than or equal to 5 to 6 mm Hg decrease in IOP (and other levels) was calculated. Depending on the prior, the probability of achieving a greater than or equal to 5 mm Hg reduction in IOP in POAG varied from 0.1% to 3%. Confidence in a greater than or equal to 6 mm Hg decrease required a prior belief that phacoemulsification produces a mean decrease of 7 mm Hg. The probability of a decrease in IOP was greater in PACG: approximately 50% probability of a greater than or equal to 5 mm Hg decrease in PACG uncontrolled on medications. Phacoemulsification in POAG has a high probability of producing a small decrease in IOP that may be useful in early, well-controlled disease. The probability of a clinically significant decrease of greater than or equal to 5 to 6 mm Hg-required for advanced/uncontrolled disease-is low. Results support the role of phacoemulsification in PACG.

Clinical observation of phacoemulsification for primary angle-closure glaucoma coexisted with cataract

Clinical observation of phacoemulsification for primary angle-closure glaucoma coexisted with cataract

Determinants of Long-term Intraocular Pressure After Phacoemulsification in Primary Angle-closure Glaucoma

To determine the preoperative factors associated with long-term intraocular pressure (IOP) after cataract surgery in primary angle-closure glaucoma (PACG). The data of 56 PACG patients who had undergone phacoemulsification consecutively were analyzed after detailed chart review. The associations between postoperative IOP and various preoperative factors were determined by multivariate linear regression analyses. The mean postoperative follow-up was of 33.0±13.6 months. The postoperative IOP decreased (P<0.05 at each visit) from the preoperative level over the years, with a mean percent reduction of 20%. Glaucoma medication number also reduced significantly, except at month 30 (P=0.088), 36 (P=0.585), and 48 (P=0.104). Preoperative factors of higher IOP (P<0.001) and deeper anterior chamber depth (ACD) (P=0.006) were associated with higher postoperative IOP over the years. The multiplication product IOP×ACD accounted for 49% of the IOP variations 1 year after surgery, and eyes with this index less than or equal to 35 were more likely to achieve postoperative IOP readings of less than or equal to 12 mm Hg (odds ratio, 9.2, P=0.001) than those with an index more than 35. Long-term IOP after phacoemulsification in PACG is positively associated with preoperative IOP and preoperative ACD.