Effects of Phacoemulsification Versus Combined Phaco-trabeculectomy on Drainage Angle Status in Primary Angle Closure Glaucoma (PACG)

PurposeTo document anatomic effects of phacoemulsification versus combined phaco-trabeculectomy on drainage angle in primary angle closure glaucoma (PACG). MethodsIndentation gonioscopy and ultrasound biomicroscopy were performed preoperatively, and then at 1 year after phacoemulsification alone or combined phaco-trabeculectomy in PACG patients. ResultsSeventy-two PACG eyes of 72 patients were included in this study. Thirty-eight eyes were randomized into receiving phacoemulsification alone, whereas 34 eyes had combined phaco-trabeculectomy. The mean extent of synechial angle closure was significantly reduced from 266.4° to 198.9° (P<0.001) by phacoemulsification alone, and from 266.0° to 227.2° (P=0.03) by combined surgery. The mean angle opening distance (AOD 500) measured by ultrasound biomicroscopy was significantly increased from 208.0 to 468.0 μm (P<0.001) by phacoemulsification, and from 214.6 to 344.4 μm (P<0.001) by combined surgery. The mean trabecular-ciliary process distance was significantly increased from 824.6 to 1043.6 μm (P<0.001) by phacoemulsification, and from 800.9 to 951.5 μm (P=0.01) by combined surgery. The mean anterior chamber depth was significantly increased from 1798.6 to 3528.4 μm (P<0.001) by phacoemulsification alone, and from 1781.6 to 3297.8 μm (P<0.001) by combined surgery. Phacoemulsification alone resulted in significantly greater postoperative angle opening distance 500 (P<0.001) and anterior chamber depth (P<0.001) than phaco-trabeculectomy. ConclusionsPhacoemulsification alone resulted in greater opening of drainage angle and greater deepening of anterior chamber than combined phaco-trabeculectomy in PACG eyes. SynopsisPhacoemulsification alone resulted in greater opening of drainage angle and greater deepening of anterior chamber than combined phaco-trabeculectomy in PACG eyes.

[1]  D. Lam,et al.  Correlation of previous acute angle-closure attack with extent of synechial angle closure in chronic primary angle-closure glaucoma patients , 2009, Eye.

[2]  C. Tham,et al.  Phacoemulsification versus combined phacotrabeculectomy in medically controlled chronic angle closure glaucoma with cataract. , 2008, Ophthalmology.

[3]  C. Tham,et al.  The Clinical Outcomes of Cataract Extraction by Phacoemulsification in Eyes With Primary Angle-Closure Glaucoma (PACG) and Co-Existing Cataract: A Prospective Case Series , 2006, Journal of glaucoma.

[4]  F. Gunning,et al.  Uncontrolled primary angle closure glaucoma: results of early intercapsular cataract extraction and posterior chamber lens implantation , 1991, International Ophthalmology.

[5]  E. Greve.  Primary angle closure glaucoma: Extracapsular cataract extraction or filtering procedure? , 2004, International Ophthalmology.

[6]  T. Kubota,et al.  Phacoemulsification and Intraocular Lens Implantation for Angle Closure Glaucoma after the Relief of Pupillary Block , 2003, Ophthalmologica.

[7]  David S Friedman,et al.  A prospective ultrasound biomicroscopy evaluation of changes in anterior segment morphology after laser iridotomy in Asian eyes. , 2003, Ophthalmology.

[8]  R. Ritch,et al.  Iridociliary apposition in plateau iris syndrome persists after cataract extraction. , 2002, American journal of ophthalmology.

[9]  E. Balestrazzi,et al.  Phacoemulsification and intraocular lens implant in eyes with primary angle-closure glaucoma: our experience. , 2002, Acta ophthalmologica Scandinavica. Supplement.

[10]  H. Hayashi,et al.  Effect of cataract surgery on intraocular pressure control in glaucoma patients , 2001, Journal of cataract and refractive surgery.

[11]  C. Tham,et al.  The Efficacy and Safety of Combined Phacoemulsification, Intraocular Lens Implantation, and Limited Goniosynechialysis, Followed by Diode Laser Peripheral Iridoplasty, in the Treatment of Cataract and Chronic Angle-closure Glaucoma , 2001, Journal of glaucoma.

[12]  J. Lai,et al.  Changes in AC angle width and depth after IOL implantation in eyes with glaucoma. , 2001, Ophthalmology (Rochester, Minn.).

[13]  J Katz,et al.  Criteria for progression of glaucoma in clinical management and in outcome studies. , 2000, American journal of ophthalmology.

[14]  R Ritch,et al.  Inadvertent corneal indentation can cause artifactitious widening of the iridocorneal angle on ultrasound biomicroscopy. , 2000, Ophthalmic surgery and lasers.

[15]  H. Hayashi,et al.  Changes in anterior chamber angle width and depth after intraocular lens implantation in eyes with glaucoma. , 2000, Ophthalmology.

[16]  J. Ge,et al.  New management of angle-closure glaucoma by phacoemulsification with foldable posterior chamber intraocular lens implantation. , 2000, Yan ke xue bao = Eye science.

[17]  F. Gunning,et al.  Lens extraction for uncontrolled angle‐closure glaucoma: Long‐term follow‐up , 1998, Journal of cataract and refractive surgery.

[18]  Chang-Hao Yang,et al.  Intraocular lens position and anterior chamber angle changes after cataract extraction in eyes with primary angle‐closure glaucoma , 1997, Journal of cataract and refractive surgery.

[19]  J. Salmon,et al.  Extracapsular cataract extraction with posterior chamber lens implantation in primary angle‐closure glaucoma , 1997, Journal of cataract and refractive surgery.

[20]  F. S. Foster,et al.  Ultrasound Biomicroscopy of the Eye , 1994, Springer New York.

[21]  P. Atkinson,et al.  Extracapsular cataract extraction and posterior chamber lens implantation in patients with primary chronic angle-closure glaucoma: Effect on intraocular pressure control , 1989, Eye.