Treatment Of Angle-closure Glaucoma Research Articles

ACETAZOLAMIDE INDUCED SECONDARY ANGLE CLOSURE GLAUCOMA: A RARE CASE REPORT

Introduction : Drugs such as topiramate, acetazolamide, methazolamide, buproprion, and trimethoprim- sulfamethoxazole potentially cause an elevation of IOP. Drug-induced glaucoma may be an ophthalmic emergency if not treated promptly and can results in permanent visual loss.
 Case Illustration : A 36-years-old female came to Glaucoma Unit at Cicendo National Eye Hospital with progressive blurred vision since 1 year ago, worsening in the past six months. Accompanying symptoms included pain, headache, halo, and conjunctival hyperemia. She had been diagnosed with glaucoma and received timolol maleate, acetazolamide, and glycerin. Seven days later, her visual acuity worsened to 3/60 ph 0.15 RE and 2/60 ph 0.15 LE, with high IOP in both eyes, with the higher IOP being >30 mmHg. The cup-to-disc ratio was 0.3 RE and 0,8 LE. The anterior segment showed shallow anterior chamber, mid-dilated pupil, and conjunctival injection (Figure 1.). Gonioscopy examination showed Schwalbe line of both eyes (Figure 2.). Acetazolamide was stopped, and one week later the condition resolved (Figure 3.).
 Discussion : Secondary angle closure glaucoma caused by acetazolamide is important to consider because most people tolerate acetazolamide well. The mechanism of closed-angle glaucoma can be pupillary block and non-pupillary block. Non-pupillary block is caused by thickening, forward movement the iris-lens diaphragm, rotation of the ciliary body, and choroidal effusion. This process is an idiosyncratic reaction to certain systemic drugs.
 Conclusion : Few cases were reported about secondary bilateral angle closure glaucoma due to acetazolamide. Treatment of angle closure glaucoma involves stopping acetazolamide

Inhibition of NOX4 with GLX351322 alleviates acute ocular hypertension-induced retinal inflammation and injury by suppressing ROS mediated redox-sensitive factors activation

Reactive oxygen species (ROS) overproduction plays an essential role in the etiology of ischemic/hypoxic retinopathy caused by acute glaucoma. NADPH oxidase (NOX) 4 was discovered as one of the main sources of ROS in glaucoma. However, the role and potential mechanisms of NOX4 in acute glaucoma have not been fully elucidated. Therefore, the current study aims to investigate the NOX4 inhibitor GLX351322 that targets NOX4 inhibition in acute ocular hypertension (AOH)-induced retinal ischemia/hypoxia injury in mice. Herein, NOX4 was highly expressed in AOH retinas, particularly the retinal ganglion cell layer (GCL). Importantly, the NOX4 inhibitor GLX351322 reduced ROS overproduction, inhibited inflammatory factor release, suppressed glial cell activation and hyperplasia, inhibited leukocyte infiltration, reduced retinal cell senescence and apoptosis in damaged areas, reduced retinal degeneration and improved retinal function. This neuroprotective effect is at least partially associated with mediated redox-sensitive factor (HIF-1α, NF-κB, and MAPKs) pathways by NOX4-derived ROS overproduction. These results suggest that inhibition of NOX4 with GLX351322 attenuated AOH-induced retinal inflammation, cellular senescence, and apoptosis by inhibiting the activation of the redox-sensitive factor pathway mediated by ROS overproduction, thereby protecting retinal structure and function. Targeted inhibition of NOX4 is expected to be a new idea in the treatment of acute glaucoma.

Diagnosis and treatment of angle-closure glaucoma

Glaucoma is a polyetiological disease, which is based on increased intraocular pressure, leading to impaired visual fields and pathology of the optic nerve. As a result of increased pressure, there is an increase in the hydrodynamic load on the optic disc, gradually leading to its atrophy. Progressive narrowing of visual fields is another classic sign of glaucoma. This disease is one of the main causes of vision loss and related disability of the population. There are three main forms of glaucoma: primary open-angle, primary closed-angle, and secondary glaucoma, which develops against the background of the existing pathology of the organs of vision (diabetic retinopathy, acute iridocyclitis, post-thrombotic oculopathy). Primary open-angle glaucoma is the most common form of the disease, usually affecting the elderly. Angle-closure glaucoma is less common, but it is more dangerous. This form of the disease is often observed against the background of existing hypermetropia. This type of primary glaucoma develops as a result of a violation of the outflow in the drainage system of the eye due to the occlusion of the internal scleral sinus. In this case, the anterior chamber is significantly reduced in size or even disappears, and the lens is close to the cornea. Angle-closure glaucoma is characterized by a paroxysmal course, rapid progression, and a less favorable prognosis. In some cases, an acute attack of angle-closure glaucoma requires immediate hospitalization with subsequent surgical intervention.

Phacoemulsification combined with goniosynechialysis under a gonioscope in the treatment of angle-closure glaucoma: the effect of reopening the synechial anterior chamber angle

A total of 170 consecutive patients (181 eyes) who were diagnosed with primary angle-closure glaucoma (PACG) and underwent phacoemulsification and intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) with an instrument under a gonioscope in the Eye Hospital, Wenzhou Medical University from January 1, 2017 to December 31, 2019 were observed. Anterior chamber angle synechiae of 0 (0, 2) clock hour were released after PEI, while after combined goniosynechialysis, synechiae of 6 (3, 8) clock hours were further released. No matter in chronic PACG and acute PACG with cornea edema, the extent of anterior chamber angle synechiae was different before surgery and after PEI, and so was it in post-PEI and PEI-GSL prospectively (all P<0.01). Phacoemulsification alone can reopen the synechial anterior chamber angle in both chronic PACG and acute PACG in part, but not sufficiently. Combined goniosynechialysis under a gonioscope with an instrument is essential and effective.

Numerical study of aqueous humor flow and iris deformation with pupillary block and the efficacy of laser peripheral iridotomy

BackgroundDisclosing the mechanism of primary angle closure glaucoma with pupillary block is important to the diagnosis as well as treatments, such as the laser peripheral iridotomy. Comparing with abundant clinical researches, there have been fewer quantitative studies of the aqueous humor flows with synechia iris configurations, and the efficacy of laser peripheral iridotomy in treating glaucoma. MethodsBased on the mathematical models of aqueous humor flow and iris deformation, the flow fields were simulated by computational fluid dynamics with normal and synechia iris configurations (iris-lens gap of 30, 5 and 2 μm, respectively), and through one-way fluid-structure coupling technique the deformations of the iris under the flow field pressure were calculated by finite element analysis. The efficacy of glaucoma treatment with different orifice sizes was also investigated. FindingsResults show that the pressure difference between anterior and posterior chambers and iris deformation increase dramatically with the iris-lens gap distance less than 5 μm, and when further decreasing this gap may lead the iris touch the cornea causing angle closure glaucoma with noticeable iris bombé. Laser peripheral iridotomy simulation results show that iridotomy size of 0.2 mm can effectively decrease the pressure difference across the iris and relieve iris bombé. InterpretationThis is a biomechanical numerical study, and the results are reasonable compare to those of published works. It may shed additional light on the diagnosis and treatment of angle closure glaucoma with pupillary block.

Advances of minimally invasive glaucoma surgery in the combined treatment of primary angle-closure glaucoma

Glaucoma is the leading irreversible blinding eye disease worldwide, and China has the largest amount of primary angle-closure glaucoma (PACG). To reduce blindness, the therapeutic evolution can play a role. With the technical development of minimally invasive glaucoma surgery (MIGS), the treatment of angle-closure glaucoma has been in a transformation. This article reviews the literatures related to the advances of MIGS in the combined treatment of PACG. The research findings show that MIGS may become one of the preferred surgical treatments for PACG in the future clinical management of glaucoma.

Pathogenetic Justification of a New View on the Treatment of Angle-Closure Glaucoma

Purpose. To study the effectiveness of vascular, anti-inflammatory and fibrinolytic therapy, to conduct a comparative assessment with treatment without vascular therapy in patients with angle-closure (ACG) and mixed glaucoma.Methods. A total of 55 patients with angle-closure and mixed glaucoma, mainly with hypermetropic refraction of varying degrees, were examined: 7 people with acute glaucoma attack, 6 people with subacute glaucoma attack (group 1, with anti-inflammatory treatment), 7 people with acute glaucoma attack and 6 people with subacute glaucoma attack (group 2, with vascular treatment), 14 people with chronic angle-closure glaucoma (group 3) and 15 people with mixed glaucoma (group 4). All patients underwent an ophthalmological examination, which included visometry, refractometry, tonometry, computer perimetry, OCT and OCT angiography, and an ELISA analysis to determine cytokines.Results. The administration of the drug Pentoxifylline as a cytokine blocker and antiplatelet agent in ACG contributed, in our opinion, to an improvement in visual acuity, perimetry (MD), an increase in the density of capillaries of the deep vascular plexus at the level of lamina cribrosa in the peripapillary zone (%), i.e. improved blood circulation in the vessels of the optic nerve disc and also contributed to the blockade of cytokines, mainly in the 2-nd group of patients. In our opinion, a personalized approach to the treatment of ACG is to maintain the improvement of blood circulation in the peripapillary zone by prescribing a course of treatment with Pentoxifylline for 6 months after surgery. After phacoemulsification, there was a significant increase in the density of capillaries of the deep peripapillary vascular plexus at the level of lamina cribrosa (p ≤ 0.05) (51.0 ± 3.5 %), and after further treatment with Pentoxifylline, the capillary density continued to increase in 2–4 groups in the next 6 months of follow-up. The thickness of RNFL (Retinal nerve fiber layer, structural parameter) decreased due to a decrease in edema in 1–2 groups, slightly increased in 3–4 groups, in our opinion, due to improved blood circulation. Increased reperfusion in the capillaries of the deep plexus during normalization of IOP in glaucoma patients and further treatment with pentoxifylline indicates the effectiveness of the proposed treatment in addition to surgical treatment. The results obtained emphasize the advantages of the proposed therapy for the treatment of patients with angle-closure and mixed glaucoma.Conclusion. To date, there are no clear recommendations of vascular therapy for the treatment of patients with ACG and mixed glaucoma, which creates the need for its addition to treatment regimens, taking into account the vascular component of ACG and mixed glaucoma.

Algorithm for Performing Laser Iridectomy in Patients with Angle-Closure Glaucoma and Concomitant Somatic Pathology

Тhe main treatment for angle-closure glaucoma is laser iridectomy. Somatic comorbidity (autoimmune, allergic, chronic infectious diseases) affects the results of laser iridectomy.Purpose: to evaluate in practice the algorithm for applying the method of laser iridectomy in compliance with preventive measures, including medical support before and after surgery, both in patients with concomitant somatic pathology and without it.Patients and methods. The analysis of combined laser iridectomy’s results in 61 patients (94 eyes) was carried out. A method was used to determine the tactics of management the patients with latent stage of angle-closure glaucoma and pigment dispersion syndrome (Patent RU N 2726404), including an assessment of the general immune status based on information about somatic diseases and medications taken. Combined laser iridectomy was performed in two stages in one visit. The first stage is coagulation in the projection of the lacunae at the periphery of the iris; at the second stage, two through holes were formed. All patients received medication in accordance with the algorithm. The level of reactive hypertension was assessed in 1 hour after surgery, on the first and seventh days after the intervention.Results. In case of standard medical support for laser iridectomy, the level of reactive hypertension is higher in the group of patients with concomitant somatic pathology than without it. Adding additions to the standard drug regimen in a group of patients with impaired general immune status ensures that the target intraocular pressure is achieved. The use of an algorithm for performing laser iridectomy in patients with angle-closure glaucoma and concomitant somatic pathology makes it possible to achieve the target intraocular pressure early after surgery and to avoid complications.

The efficacy of different operations for angle-closure glaucoma caused by abnormal suspension ligament

Objective To evaluate the effeicacy of phacoemulsification combined with intracapsular tension ring implantation in the treatment of angle closure glaucoma (ACG) caused by abnormal suspension ligament (ASL). Methods The data of 64 eyes of 60 cases with ACG caused by ASL from Jun. 2016 to Jun. 2018 in this hospital were analyzed retrospectively.According to the random distribution, all patients were divided into two groups, with 30 cases in each group.Group A underwent phacoemulsification combined with intraocular lens implantation, group B underwent phacoemulsification combined with intracapsular tension ring implantation. Results The intraocular pressure at 1 day and 1 month after operation in the two groups were lower than that before operation, and that of group B was lower than that of group A. The difference was statistically significant (P<0.001). BCVA after operation was higher than that before operation in two groups, BCVA in group B was better than that in group A, and the difference was statistically significant (P<0.001). The central anterior chamber depth of both groups was deeper than that before operation, and that of group B was significantly greater than that of group A (P<0.001). The difference of complication rates was not statistically significant between the two groups (P=0.688). Conclusion Phacoemulsification combined with intracapsular tension ring implantation in the treatment of ACG caused by ASL is effective, which can effectively ameliorate the intraocular pressure, BCVA and central anterior chamber depth. Key words: Phacoemulsification; Tension ring, capsular, implantation; Abnormality, suspension ligament; Glaucoma, angle-closure

A Novel Synthetic Steroid of 2β,3α,5α-Trihydroxy-androst-6-one Alleviates the Loss of Rat Retinal Ganglion Cells Caused by Acute Intraocular Hypertension via Inhibiting the Inflammatory Activation of Microglia.

Neuroinflammation has been well recognized as a key pathological event in acute glaucoma. The medical therapy of acute glaucoma mainly focuses on lowering intraocular pressure (IOP), while there are still scarce anti-inflammatory agents in the clinical treatment of acute glaucoma. Here we reported that β,3α,5α-trihydroxy-androst-6-one (sterone), a novel synthetic polyhydric steroid, blocked neuroinflammation mediated by microglia/macrophages and alleviated the loss of retinal ganglion cells (RGCs) caused by acute intraocular hypertension (AIH). The results showed that sterone significantly inhibited the morphological changes, the up-regulation of inflammatory biomarker ionized calcium-binding adapter molecule 1 (Iba-1), and the mRNA increase of proinflammatory tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6) induced by lipopolysaccharide (LPS) in BV2 microglia and RAW264.7 macrophages. Moreover, immunofluorescence and western blotting analysis revealed that sterone markedly abrogated the nuclear translocation and phosphorylation of nuclear factor-κB (NF-κB) p65 subunit. Furthermore, sterone significantly suppressed the inflammatory microglial activation and RGCs’ reduction caused by retinal ischemia/reperfusion (I/R) injury in a rat AIH model. These results suggest sterone may be a potential candidate in the treatment of acute glaucoma caused by microglial activation-mediated neuroinflammatory injury.

Changing patterns in treatment of angle closure glaucoma.

Angle closure glaucoma is a leading cause of blindness globally and trends of how best to treat this disease are evolving. The advent of anterior segment imaging aids our understanding of pathogenesis and allows more robust and objective measurement of treatment modalities. We will also review recent literature regarding the role of laser and surgical interventions for the treatment of primary angle closure disease. Recent studies evaluating the efficacy of laser peripheral iridotomy (LPI) in primary angle closure suspects (PACs) show that while it is a safe intervention and initially anterior chamber angle widens following the laser treatment, the effect is lost with time. Only a small minority of PACs patients develop primary angle closure (PAC) or primary angle closure glaucoma (PACG). Trials evaluating argon laser peripheral iridoplasty (ALPI) have failed to show a substantial clinical benefit. In patients with early or moderate PACG and those with PAC with IOP over 30 mmHg, clear lens extraction is associated with better clinical and quality of life outcomes than LPI. Recent evidence supports initial clear lens extraction in the context of PACG or primary angle closure with IOP more than 30 mmHg.

Angle-closure glaucoma

In India primary angle closure disease comprises approximately fifty percent of primary glaucoma. It is the leading cause of blindness from glaucoma. Appropriate identification and institution of therapy can prevent long term morbidity from this disease. The use of Pilocarpine and the application of laser iridotomy early in the treatment of angle closure glaucoma has to be underscored. Long term prognosis depends upon identification of the variety of presentations and appropriate use of medical and laser and surgical therapy to maintain a good quality of life for the patients. Family screening plays an important role in detecting new patients at an early stage of the disease.

Chandelier Illumination for Descemet Membrane Endothelial Keratoplasty.

To describe a simple technique that uses posterior chandelier illumination during Descemet membrane endothelial keratoplasty in cases of severe bullous keratopathy (BK). Five eyes of 4 patients with advanced BK undergoing Descemet membrane endothelial keratoplasty were retrospectively analyzed. The pupil of the host eye was not treated with mydriatic or miotic agents. The chandelier illuminator was inserted transconjunctivally into the vitreous cavity from the pars plana. In all eyes, BK was secondary to laser iridotomy, which was performed for prevention or treatment of angle closure glaucoma. The implanted graft was clearly confirmed in the anterior chamber using activated chandelier illumination. The graft was immediately attached to the host cornea, with eventual healing of BK in all eyes. No complication involving insertion or removal of the 25-gauge trocar and the chandelier illuminator was observed. No vision-threatening complication was observed in any of the 5 eyes. The chandelier illuminator provided good visibility of the anterior chamber and enhanced the safety of surgery by preventing formation of an inverted graft.

Treatment of angle-closure glaucoma with cataract

Objective To investigate the clinical efficacy of phacoemulsification and intraocular lens implantation in treatment of angle-closure glaucoma with cataract. Methods Sixty-four eyes of 64 cases with primary angle-closure glaucoma with cataract were selected and randomly divided into clinical trial group and the control group (n=32) according to the different methods of treatment. Patients in the trial group received phacoemulsification combined intraocular lens (IOL) implantation, the control group underwent phaco emulsification combined artificial lens implantation and peripheral iridectomy treatment. The efficacy and complications of two groups were observed. Results The difference in visual acuity and IOP between before and after surgery were not statistically significant (P> 0.05). Postoperative follow-up of 6 months, the vision ≥0.5 in experimental group were in 75.00%, intraocular pressure were (14.16±1.42) mmHg(1 mmHg=0.133 kPa), the vision ≥0.5 in control group were in 46.88 %, intraocular pressure were (14.27±1.65) mmHg. In the trial group the improvement of visual acuity and intraocular pressure were better than those of in the control group, the difference were statistically significant (P< 0.05). The complication rate of trial group was 9.38%, it was significantly lower than that of the control group 28.13%, the difference between the two groups was statistically significant.(P<0.05). Conclusion Phacoemulsification and intraocular lens implantation treated angle-closure glaucoma with cataract can improve the treatment effect, reduce the incidence of complications, it has small trauma and high safety. Key words: Glaucoma, closed-angle, primary; Cataract; Phacoemulsification

Phacoemulsification combined with trabeculectomy for angle-closure glaucoma with cataract

Objective To evaluate the clinical efficacy of phacoemulsification combined with trabeculectomy for the treatment of angle-closure glaucoma with cataract. Methods Thirty-eight eyes of 32 cases with angle-closure glaucoma with cataract were selected and retrospectively analyzed.All cases underwent phacoemulsification combined with trabeculectomy. The visual acuity, intraocular pressure, anterior chamber depth and complications in pre- and post-operation were observed. Results The follow-up time was 3-12 months. The average intraocular pressure were(25.8±3.9)mmHg(1 mmHg=0.133 kPa) and (14.2±4.1)mmHg in pre- and post-operation respectively, and the difference was statistically significant (t=12.637, P=0.000). The high intraocular pressure after operation occurred in 2 eyes, 1 eye intraocular pressure decreased to normal range after topical anti glaucoma drugs treatment for 2 days, and the other eye received trabeculectomy again. The visual acuity≥ 0.3 was in 11 eyes preoperatively and 36 eyes postoperatively .The difference was statistically significant (χ2=34.8500, P=0.0000). The anterior chamber depth in pre-and post-operation were (2.0±0.3) mm and (3.7±0.4) mm respectively, the difference was statistically significant between before and after treatment.(t=-20.959, P=0.000). Hyphema occurred in 3 eyes (7.9%), corneal edema in 5 eyes (13.2%), and anterior chamber inflammation in 5 eyes (13.2%), they were corrected after symptomatic treatment. No posterior capsular rupture and after-cataract happened. Conclusion Phacoemulsification combined with trabeculectomy for angle-closure glaucoma with cataract can effectively improve vision, reduce intraocular pressure and deepen the anterior chamber depth. Key words: Glaucoma, angle-closure; Cataract; Phacoemulsification; Trabeculectomy

Clinical analysis on angle-closure glaucoma with binocular asymmetry of anterior chamber depth

Objective To analyze clinical features and treatment for angle-closure glaucoma with binocular asymmetry of anterior chamber depth. Methods Twenty-one eyes of 21 cases with binocular asymmetry of anterior chamber depth were analyzed retrospectively (relaxation of ciliary zonule in 2 cases; subluxation of lens in 18 cases; glaucoma secondary to retinal vascular occlusion in 1 case). All cases were characterized by high intraocular pressure, shallow anterior chamber, anterior chamber angle closure, and similar to primary angle closure glaucoma. Ectopia lentis occurred in 20 cases. All cases underwent YAG laser peripheral iridotomy, trabeculectomy or lens extraction, even combined with anterior vitrectomy. The posterior chamber lenses were implanted into the capsular bag or suspended according to the different instances of relaxation of ciliary zonule. Secondary glaucoma was treated with intravitreal injection of Conbercept. Results After operation, all cases obtained normal intraocular pressure and visual acuity increased to 0.12-0.8. Conclusion It is very important to differentiate the patients of glaucoma due to binocular asymmetry of anterior chamber depth from primary angle-closure glaucoma. Good surgical efficacy can be obtained via different types of operations according to different situations of diseases. Key words: Zonule, len, relaxation; Glaucoma, secondary; Retinal vascular occlusion; Anterior chamber depth

Efficacy observation of phacoemulsification with intraocular lens implantation and goniosynechialysis in the treatment of angle-closure glaucoma

Efficacy observation of phacoemulsification with intraocular lens implantation and goniosynechialysis in the treatment of angle-closure glaucoma

Surgical Treatment of Angle-Closure Glaucoma.

Advances in anterior segment imaging modalities have contributed new insights towards a better understanding of the various mechanisms of angle-closure glaucoma (ACG). This development is key to good decision making when confronted with angle-closure patients needing appropriate therapy. Surgical management of ACG remains an integral part of glaucoma patient care. The distinctive anatomy of angle-closure eyes and the few objective lines of evidence to support the effectiveness of the different surgical treatment options present a challenge to glaucoma surgeons.

Phacoemulsification combined with goniosynechialysis for the treatment of angle-closure glaucoma with cataract

Objective To observe the effect of phacoemulsification combined with goniosynechialysis for the treatment of angle-closure glaucoma with cataract. Methods From January 2012 to August 2014, 30 eyes of 30 patients with acute angle-closure glaucoma and coexisting cataract, and 27 eyes of 19 patients with chronic angle-closure glaucoma and coexisting cataract in our hospital were selected. All patients underwent phacoemulsification combined with goniosynechialysis.The intraocular pressure, visual acuity and complications before and after the surgery were observed and compared. Results All patients were followed up for 6-12 months. The intraocular pressure of the patients in two groups were reduced to normal after the surgery (P<0.05). The visual acuity of patients in two groups were improved after the surgery(P<0.05). The incidence of postoperative complications in patients with chronic angle-closure glaucoma was lower than that in patients with acute angle-closure glaucoma. Conclusion The phacoemulsification combined with goniosynechialysis for angle-closure glaucoma and coexisting cataract has good effect. Key words: Phacoemulsification; Goniosynechialysis; Glaucoma, angle-closure; Cataract

Effects of phacoemulsification and intraocular lens implantation combined with ciliarotomy in the treatment of angle-closure glaucoma with cataract.

The aim of the present study was to examine the effects of phacoemulsification and intraocular lens implantation combined with ciliarotomy in the treatment of angle-closure glaucoma with cataract in the elderly. A total of 68 patients were consecutively selected and divided into the control group with 33 cases (48 eyes) and the observation group with 35 cases (53 eyes). Cataract surgery combined with trabeculectomy was performed on the patients in the control group and phacoemulsification cataract extraction combined with ciliarotomy was performed on the subjects in the observation group, to compare postoperative effects and complications. Following surgery, the visual acuity of patients in the two groups significantly improved, intraocular pressure decreased, and improvement of the observation group was more evident (P<0.05). Following surgery, the depth of central anterior chamber and width of chamber angle of patients in two groups was increased, and improvement of the observation group was significantly more evident (P<0.05). Additionally, the incidence of complications, including corneal swelling, shallow of anterior chamber, fibrinous exudate in iris, and filtering bleb leaking and following cataract removal, of patients in the observation group was significantly reduced compared to the control group (P<0.05). In summary, the results of the present study show that, phacoemulsification and intraocular lens implantation combined with ciliarotomy in the treatment of angle-closure glaucoma with cataract in the elderly is a safe and effective method and should be applied in the clinic.