Primary phacoemulsification for treatment of angle-closure glaucoma patients with uncontrolled intraocular pressure

Poster Details

First Author: M.Pravosudova RUSSIA

Co Author(s):    L. Balashevich              

Abstract Details

Purpose:

To evaluate the clinical outcomes of lens extraction by phacoemulsification with intraocular lens (IOL) in primary angle-closure glaucoma (PACG) eyes with uncontrolled intraocular pressure (IOP).

Setting:

: Sv. Fyodorov Eye Microsurgery Clinic, St.Petersburg Branch, Russia.

Methods:

In our prospective study we included 87 patients (105 eyes) with PACG. IOP remained uncontrolled in all cases despite of using laser iridotomy and iridoplasty. Phacoemulsification with intraocular lens (IOL) implantation was performed in 57 eyes (main group), deep sclerectomy - in 48 eyes (control group). Detailed ophthalmologic examination included standart methods and also high-speed optical coherence tomography (OCT). All patients were followed up for 2-6 years.

Results:

During long-term follow-up good IOP control was occurred in all eyes. After phacoemulsification IOP decreased from the mean preoperative level of 32.2 mm Hg to 19.2 mm Hg at the final follow-up. In 52.6% eyes IOP control was controlled without medications. The number of medications decreased from 2.4 to 0.54. In this group the mean visual acuity was 0.76 (I-II stages – 0.82, III stage – 0.4) in long-term follow-up and all patients had stable visual fields. OCT examination showed significant deepening of the anterior chamber from 1.91 to 3.18 mm, increasing of the trabecular-iris angle from 17.2 to 36.9 degrees at average, disclosure of the anterior chamber angle in some quadrants, appearance of free space between the posterior iris surface and IOL in 20 eyes (35.1%) after phacoemulsification. After deep sclerectomy we recorded 2 serious complications, which were accompanied by flat anterior chamber, IOP increasing, decreasing of visual acuity and needed subsequent surgical procedures.

Conclusions:

The data of our study revealed significant changes of the anterior segment in PACG eyes after phacoemulsification. It allows us to create the favorable conditions for aqueous humor outflow and achieve good IOP control in these eyes. After phacoemulsification perfect visual results were produced and visual functions remained stable. We recommend primary phacoemulsification for treatment of PACG patients instead of traditional penetrating glaucoma operations. We have no financial interest in this research.

Financial Disclosure:

None

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