The change in visual field and optic disk parameters, intraocular pressure and the number of anti-glaucoma medications after clear lens extraction in primary angle closure glaucoma patients

Session Details

Session Title: Presented Poster Session 10: Cataract Surgery Special Cases

Session Date/Time: Sunday 14/09/2014 | 15:00-17:00

Paper Time: 15:30

Venue: Pod 1 (Poster Village)

First Author: : N.Tamcelik TURKEY

Co Author(s): :    E. Atalay   O. Capar   C. Arici   E. Cicik     

Abstract Details

Purpose:

Clear lens extraction has been described as an effective treatment modality in patients with primary angle closure glaucoma. However, surgeons might not feel very comfortable to operate on eyes with clear lenses that already have shallow anterior chambers which create a predisposition to higher intra-operative and post-operative complications. The primary aim of this study is to evaluate the change in visual field and optic disk parameters, intraocular pressures and the number of anti-glaucoma medications in primary angle closure glaucoma patients that have undergone clear lens extraction.

Setting:

This retrospective study has been conducted in a university based hospital and consisted of patients with primary angle closure glaucoma.

Methods:

The charts of the patients with primary angle closure glaucoma who underwent clear lens extraction have been reviewed. Patients who underwent previous glaucoma surgery, with the exception of previous laser or surgical iridotomy, were excluded. Intraocular pressure (IOP), the number of anti-glaucoma medication, visual field and optic disk parameters within the pre-operative 3 month period and postoperative 1 year period have been recorded. Visual field testing had been performed by Humphrey Visual Field Analyzer 750i and optic disk parameters were analyzed using Heidelberg Retinal Tomography III. Variables that have been assessed by these devices included visual field index (VFI), mean deviation (MD), pattern standard deviation (PSD), linear cup to disk ratio (C/D), and rim area (RA).

Results:

19 eyes of 12 patients (3 male, 9 female) were included in the study. The mean age of the patients was 62.83±13.47 years. All patients had undergone laser iridotomy long before the lens removal. One patient required surgical iridotomy in addition to laser iridotomy. No major complications were observed postoperatively. The mean values for pre-postoperative; IOP was 26.21±7.70 mmHg – 14.10±2.86 mmHg, VFI was 85.12%±21.25% – 86.37±21.75%, MD was 6.83±7.42 dB – 5.59±7.00 dB, PSD was 5.16±4.21 dB – 5.24±4.21 dB, C/D was 0.54±0.24 – 0.54±0.26, RA was 1.15±0.44mm2 – 1.15±0.46mm2. Visual acuity increased in all patients with pre-operative BCVA less than 20/20. The mean number of anti-glaucoma medications before the surgery was 2.35±0.7 which decreased to 0.29±0.46. Twelve of the eyes did not require any medication after the surgery.

Conclusions:

Patients clearly benefited from clear lens extraction in terms of IOP control. This is not only demonstrated as a reduction in IOP but also as a reduction in the number of anti-glaucoma medications required. Visual field parameters and measurements of C/D and rim area did not change significantly after the lens removal. Clear lens extraction may be suggested as an effective treatment option in primary angle closure glaucoma patients, particularly in patients who possess lens related mechanisms.

Financial Interest:

NONE