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Effect of Phacoemulsification on Drainage Angle Status in Angle Closure Eyes with or without Extensive Peripheral Anterior Synechiae. Eur J Ophthalmol 2018; 23:70 - 79. [DOI: 10.5301/ejo.5000191] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2012] [Indexed: 11/20/2022]
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Abstract
PURPOSE Acute angle closure attacks are frequently accompanied by corneal edema. However, little is known about corneal endothelial cell status at different stages of angle closure. Here, we compared endothelial cell density (ECD) in unoperated eyes with that in eyes with open angles (OAs) and various stages of angle closure disease. MATERIALS AND METHODS The study was conducted at Aravind Eye Hospitals in India. Masked examiners performed gonioscopy to classify each eye as follows: (1) OA, (2) primary angle closure suspect, or (3) primary angle closure (PAC)/primary angle closure glaucoma (PACG). Specular microscopy was performed and differences in ECD were analyzed using hierarchical models. RESULTS A total of 407 patients and 814 eyes were studied, including 127 (15.6%), 466 (57.3%), and 221 (27.1%) with PAC/PACG, primary angle closure suspect, and OA, respectively. Participants were predominantly female (69.8%) and the mean age was 49.2 (SD: 8.6) years. Lower ECD was observed with increasing age [β=-6.3 cells/mm; 95% confidence interval (CI), -9.3 to -3.3, per year; P<0.001], greater iridotrabecular contact [β=-15.6 cells/mm; 95% CI, -28.3 to -2.9, per quadrant of contact; P=0.016), and shallow (<2.5 mm) anterior chamber depth (β=-40 cells/mm; compared to deeper AC's (≥2.5 mm), 95% CI, 78.9-1.1; P=0.044). In age-adjusted analyses, angle closure suspects had lower ECD than OA eyes (β=-54.7 cells/mm; 95% CI, -47.8 to -85.3; P=0.018), although PAC/PACG eyes were not significantly different from OA eyes (β=-18.6 cells/mm; 95% CI, -85.9 to 2.5; P=0.058). CONCLUSION In untreated eyes, only mild, clinically insignificant decrement in ECD was noted with angle closure.
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Trabeculectomy and Combined Phacoemulsification-Trabeculectomy: Outcomes and Risk Factors for Failure in Primary Angle Closure Glaucoma. J Glaucoma 2017; 25:763-9. [PMID: 27513900 DOI: 10.1097/ijg.0000000000000493] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate tonometric outcomes of patients with primary angle closure glaucoma (PACG) who have undergone trabeculectomy with mitomycin C (MMC) with and without concurrent phacoemulsification and to identify risk factors for postoperative failure. PATIENTS AND METHODS Retrospective cohort study of 44 eyes of 33 phakic patients who underwent trabeculectomy with MMC with or without combined phacoemulsification for PACG. The primary endpoint was qualified tonometric success at 12 months according to predefined criteria. LogMAR visual acuity, number of glaucoma medications, and postoperative complications were also evaluated. Cox proportional hazard regression analysis was performed to identify potential risk factors for trabeculectomy failure. RESULTS Mean intraocular pressure (IOP) decreased from 21.3±7.9 to 12.2±3.9 mm Hg at 12 months (P<0.001) in all patients. A significant reduction in mean number of glaucoma medications (P<0.001) was also seen. There was no change in logMAR visual acuity (P=0.39) after 12 months. There were no significant intergroup differences in mean IOP (P=0.42), number of glaucoma medications (P=0.85), or logMAR visual acuity (P=0.42) between the trabeculectomy versus combined surgery groups after 12 months. Increased age, greater baseline IOP, limbus-based conjunctival flaps, and MMC duration >1 minute were associated with decreased risk of surgical failure. Concurrent phacoemulsification at the time of trabeculectomy did not alter tonometric success or rate of complications. CONCLUSIONS In phakic patients with PACG, trabeculectomy with MMC significantly reduces IOP and number of glaucoma medications at 12 months without change in visual acuity. However, success rates are modest when based on more demanding tonometric criteria.
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Jimenez-Roman J, Lazcano-Gomez G, Martínez-Baez K, Turati M, Gulías-Cañizo R, Hernández-Zimbrón LF, Ochoa-De la Paz L, Zamora R, Gonzalez-Salinas R. Effect of phacoemulsification on intraocular pressure in patients with primary open angle glaucoma and pseudoexfoliation glaucoma. Int J Ophthalmol 2017; 10:1374-1378. [PMID: 28944195 DOI: 10.18240/ijo.2017.09.07] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/14/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the effect of phacoemulsification on intraocular pressure (IOP) in patients with primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). METHODS A retrospective comparative case series conducted at the Glaucoma Department at the Association to Prevent Blindness in Mexico. The study enrolled consecutive patients having phacoemulsification with intraocular lens (IOL) implantation and a diagnosis of POAG or PXG. Data about IOP values and number of glaucoma medications used was collected at baseline, 1, 3, 6 and 12mo postoperatively. RESULTS The study enrolled 88 patients (88 eyes). After phacoemulsification, there was a statistically significant reduction in IOP values and glaucoma medications use compared to baseline in both POAG and PXG patients (P<0.001). In the POAG group, a 20% decrease in IOP values was evidenced, and a 56.5% reduction in the number of medications used at the one-year follow-up. The PXG group showed a 20.39%, and a 34.46% decrease in IOP and number of medications used, respectively. A significant difference in the mean ΔIOP (postoperative changes in IOP) was evidenced between groups (P=0.005). The reduction of the postsurgical IOP mean values in both groups, the POAG group showed a greater reduction in IOP values compared to the PXG group. CONCLUSION In both types of glaucoma, phacoemulsification cataract surgery can result in a significant IOP reduction (20%) over a 12mo follow-up period. The number of medications used is also significantly reduced up to 12mo after surgery, especially in the PXG group.
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Affiliation(s)
- Jesus Jimenez-Roman
- Glaucoma Department, Asociation to Prevent Blindness in Mexico, Mexico City 04030, Mexico
| | - Gabriel Lazcano-Gomez
- Glaucoma Department, Asociation to Prevent Blindness in Mexico, Mexico City 04030, Mexico
| | - Karina Martínez-Baez
- Glaucoma Department, Asociation to Prevent Blindness in Mexico, Mexico City 04030, Mexico
| | - Mauricio Turati
- Glaucoma Department, Asociation to Prevent Blindness in Mexico, Mexico City 04030, Mexico
| | - Rosario Gulías-Cañizo
- Research Department, Asociation to Prevent Blindness in Mexico, Mexico City 04030, Mexico.,Cell Biology Department, Advanced Research Center, I.P.N. (CINVESTAV) in Mexico City, Mexico City 07360, Mexico
| | | | - Lenin Ochoa-De la Paz
- Research Department, Asociation to Prevent Blindness in Mexico, Mexico City 04030, Mexico
| | - Rubén Zamora
- Research Department, Asociation to Prevent Blindness in Mexico, Mexico City 04030, Mexico
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Teoh CS, Aquino MC, Loon SC, Chew P, Koh V. Comparing the use of phacoemulsification and combined surgery in angle-closure glaucoma. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1379901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- CS Teoh
- Department of Ophthalmology, National University Hospital of Singapore, Singapore, Singapore
| | - MC Aquino
- Department of Ophthalmology, National University Hospital of Singapore, Singapore, Singapore
| | - SC Loon
- Department of Ophthalmology, National University Hospital of Singapore, Singapore, Singapore
| | - P Chew
- Department of Ophthalmology, National University Hospital of Singapore, Singapore, Singapore
| | - V Koh
- Department of Ophthalmology, National University Hospital of Singapore, Singapore, Singapore
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Lee W, Bae HW, Kim CY, Seong GJ. The change of anterior segment parameters after cataract surgery in normal-tension glaucoma. Int J Ophthalmol 2017; 10:1239-1245. [PMID: 28861349 DOI: 10.18240/ijo.2017.08.09] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/06/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the change of anterior chamber angle morphology and intraocular pressure (IOP) reduction after cataract surgery in patients with normal-tension glaucoma (NTG) using swept-source optical coherence tomography (SS-OCT). METHODS This prospective, comparative, observational study recruited patients into two groups. Group 1 was the control group including normal subjects except those with cataracts (cataract group, n=67 eyes of 67 patients), and group 2 was NTG group including patients who were diagnosed with NTG and cataracts (n=43 eyes of 43 patients), which were treated with phacoemulsification and intraocular lens implantation. Before surgery, and at postoperative 1 and 6mo, anterior chamber angles were evaluated by SS-OCT under dark conditions using three-dimensional angle analysis scan protocol. Angle opening distance (AOD), angle recess area (ARA), and trabecular-iris surface area (TISA) at four quadrants (temporal, nasal, superior, and inferior) were calculated automatically by SS-OCT, after the observer marked scleral spurs. RESULTS A total of 106 patients (54 males and 52 females) were enrolled in the study. Angle parameters, AOD, ARA, and TISA were increased after surgery in both groups. However, changes of angle parameters were only significant in group 2. In group 2, preoperative IOP was 13.2±2.9 mm Hg, and postoperative IOP at 1 and 6mo were 10.5±3.0 and 10.7±2.8 mm Hg, respectively. In group 1, preoperative IOP was 12.4±2.8 mm Hg, and postoperative IOP at 1 and 6mo were 11.6±2.5 and 12.0±2.8 mm Hg, respectively. After cataract surgery, angle parameters changed significantly while IOP significantly reduced and was maintained in group 2 (P<0.001). The changes in angle parameters (ΔAOD500, ΔTISA500 at temporal; ΔAOD500, ΔARA500 at nasal) were linearly correlated with postoperative IOP changes. CONCLUSION Cataract surgery may have improved anterior chamber angle parameters and decreased IOP in NTG patients.
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Affiliation(s)
- Wonseok Lee
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Hyoung Won Bae
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Chan Yun Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Gong Je Seong
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul 03722, Korea
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European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition - Chapter 2: Classification and terminologySupported by the EGS Foundation: Part 1: Foreword; Introduction; Glossary; Chapter 2 Classification and Terminology. Br J Ophthalmol 2017; 101:73-127. [PMID: 28424171 PMCID: PMC5583685 DOI: 10.1136/bjophthalmol-2016-egsguideline.002] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Graber M, Khoueir Z, Beauchet A, Benhatchi N, Hammoud S, Lachkar Y. High intensity focused ultrasound as first line treatment in patients with chronic angle closure glaucoma at risk for malignant glaucoma. J Fr Ophtalmol 2017; 40:264-269. [DOI: 10.1016/j.jfo.2016.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 10/19/2022]
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Özyol P, Özyol E, Sül S, Baldemir E, Çavdar S. Intra-ocular pressure fluctuation after cataract surgery in primary angle-closure glaucoma eyes medically controlled after laser iridotomy. Acta Ophthalmol 2016; 94:e528-e533. [PMID: 27040022 DOI: 10.1111/aos.13023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 01/22/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyse the effect of cataract surgery on diurnal intra-ocular pressure (IOP) fluctuation in primary angle-closure glaucoma (PACG) eyes. METHODS Thirty-nine eyes of 24 patients with PACG scheduled for cataract surgery were enrolled to this prospective study. A record was made which included mean IOP measurement, anterior chamber depth (ACD), anterior chamber angle (ACA), number of antiglaucomatous medications, visual field analysis (mean deviation - MD and pattern standard deviation - PSD) and responses to the Glaucoma Quality of Life-15 (GQL-15) questionnaires. The eyes were re-evaluated at 2 and 3 months of cataract surgery. RESULTS IOP fluctuation was decreased from 4.58 ± 2.07 mmHg to 2.84 ± 1.5 mmHg (p < 0.001). The decrease in mean IOP, the number of glaucoma eye drops required (p < 0.001, p = 0.012, respectively) and the increase in mean ACD, ACA grading and SITA-standard MD (p < 0.001, p < 0.001, and p = 0.01, respectively) were statistically significant. The mean GQL-15 score was also improved (p < 0.001). The change in IOP fluctuation correlated positively with the preoperative IOP fluctuation (r = 0.56 p = 0.00), the change in ACD (r = 0.703, p < 0.001) and the change in ACA (r = 0.664, p < 0.001). In multivariate analysis, preoperative IOP fluctuation and postoperative increase in ACD were significantly associated with a reduction in IOP fluctuation of an average of 1.1 mmHg per unit change (p = 0.00 and p = 0.019, respectively). CONCLUSIONS Cataract surgery in PACG provides the opportunity to address many pathologies with one intervention; improving vision, diminishing IOP, blunting IOP fluctuation, reducing need for medications, eliminating a narrow angle and improving GQL-15 scores.
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Affiliation(s)
- Pelin Özyol
- Department of Ophthalmology; Faculty of Medicine; Mugla Sitki Kocman University; Mugla Turkey
| | - Erhan Özyol
- Department of Ophthalmology; Faculty of Medicine; Mugla Sitki Kocman University; Mugla Turkey
| | - Sabahattin Sül
- Department of Ophthalmology; Faculty of Medicine; Mugla Sitki Kocman University; Mugla Turkey
| | - Ercan Baldemir
- Department of Biostatistics; Faculty of Medicine; Mugla Sitki Kocman University; Mugla Turkey
| | - Sabanur Çavdar
- Department of Public Health; Faculty of Cerrahpasa Medicine; Istanbul University; Istanbul Turkey
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Melese E, Peterson JR, Feldman RM, Baker LA, Bell NP, Chuang AZ, Blieden LS. Comparing Laser Peripheral Iridotomy to Cataract Extraction in Narrow Angle Eyes Using Anterior Segment Optical Coherence Tomography. PLoS One 2016; 11:e0162283. [PMID: 27606482 PMCID: PMC5015922 DOI: 10.1371/journal.pone.0162283] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/20/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the changes in anterior chamber angle (ACA) parameters in primary angle closure (PAC) spectrum eyes before and after cataract extraction (CE) and compare to the changes after laser peripheral iridotomy (LPI) using anterior segment optical coherence tomography (ASOCT). Methods Twenty-eight PAC spectrum eyes of 18 participants who underwent CE and 34 PAC spectrum eyes of 21 participants who underwent LPI were included. ASOCT images with 3-dimensional mode angle analysis scans were taken with the CASIA SS-1000 (Tomey Corp., Nagoya, Japan) before and after CE or LPI. Mixed-effect model analysis was used to 1) compare best-corrected visual acuity, intraocular pressure, and ACA parameters before and after CE; 2) identify and estimate the effects of potential contributing factors affecting changes in ACA parameters; and 3) compare CE and LPI treatment groups. Results The increase in average angle parameters (TISA750 and TICV750) was significantly greater after CE than LPI. TICV750 increased by 102% (2.114 [±1.203] μL) after LPI and by 174% (4.546 [± 1.582] μL) after CE (P < 0.001). Change of TICV750 in the CE group was significantly affected by age (P = 0.002), race (P = 0.006), and intraocular lens power (P = 0.037). Conclusions CE results in greater anatomic changes in the ACA than LPI in PAC spectrum eyes. ASOCT may be used to follow anatomic changes in the angle after intervention.
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Affiliation(s)
- Ephrem Melese
- Robert Cizik Eye Clinic, Houston, Texas, United States of America
| | - Jeffrey R. Peterson
- Robert Cizik Eye Clinic, Houston, Texas, United States of America
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, United States of America
| | - Robert M. Feldman
- Robert Cizik Eye Clinic, Houston, Texas, United States of America
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, United States of America
| | - Laura A. Baker
- Robert Cizik Eye Clinic, Houston, Texas, United States of America
| | - Nicholas P. Bell
- Robert Cizik Eye Clinic, Houston, Texas, United States of America
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, United States of America
| | - Alice Z. Chuang
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, United States of America
| | - Lauren S. Blieden
- Robert Cizik Eye Clinic, Houston, Texas, United States of America
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, United States of America
- * E-mail:
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Wang Y, Sheng Y, Wang M, Tao J. Management of Different Subtypes of Primary Angle Closure with Phacoemulsification and Viscogoniosynechialysis. Semin Ophthalmol 2016; 32:496-500. [PMID: 27192389 DOI: 10.3109/08820538.2015.1123730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To retrospectively assess the effectiveness of combined phacoemulsification with viscogoniosynechialysis for patients with different subtypes of primary angle closure (PAC). METHODS Forty-three eyes of 37 patients diagnosed with PAC (12 eyes), PAC with glaucoma (PACG, 20 eyes), and acute PAC (11 eyes) were treated with phacoemulsification and viscogoniosynechialysis between November 2010 and October 2012. Main outcome measures were anterior chamber depth (ACD), intraocular pressure (IOP), the number of IOP-lowering medication, extent of peripheral anterior synechia (PAS), and visual acuity preoperatively and one month postoperatively. RESULTS All operations were successfully accomplished and no intra-operative complications were observed. The ACD, IOP, PAS, and visual acuity were all significantly improved postoperatively, especially in the acute PAC group, which resulted in few glaucoma drugs being needed. The IOP was decreased into equal or less than 21 mmHg in most patients postoperatively, except four patients had IOP slightly higher than 21 mmHg. However, they were restored to normal spontaneously or by medication at last follow-up. The extent of PAS was all reduced to less than 90 or 180°, with the visual acuity restored to more than 0.1. CONCLUSIONS Combined phacoemulsification with viscogoniosynechialysis seems to be an effective surgical procedure in the treatment of various subtypes of PAC.
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Affiliation(s)
- Yulan Wang
- a Department of Ophthalmology , Shanghai Aier Eye Hospital , Shanghai , China
| | - Yaohua Sheng
- a Department of Ophthalmology , Shanghai Aier Eye Hospital , Shanghai , China
| | - Min Wang
- a Department of Ophthalmology , Shanghai Aier Eye Hospital , Shanghai , China
| | - Jinhua Tao
- a Department of Ophthalmology , Shanghai Aier Eye Hospital , Shanghai , China
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Seo S, Lee CE, Kim YK, Lee SY, Jeoung JW, Park KH. Factors affecting refractive outcome after cataract surgery in primary angle-closure glaucoma. Clin Exp Ophthalmol 2016; 44:693-700. [DOI: 10.1111/ceo.12762] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/03/2016] [Accepted: 04/08/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Sam Seo
- Department of Ophthalmology; Cheil Eye Hospital; Daegu Korea
- Department of Ophthalmology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul Korea
| | - Chong Eun Lee
- Department of Ophthalmology; Keimyung University Dongsan Medical Center; Daegu Korea
- Department of Ophthalmology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul Korea
| | - Young Kook Kim
- Department of Ophthalmology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul Korea
| | - Sang Yoon Lee
- Department of Ophthalmology; Jeju National University Hospital; Jeju Korea
- Department of Ophthalmology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul Korea
| | - Ki Ho Park
- Department of Ophthalmology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul Korea
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Niyadurupola N, Broadway DC. Special considerations for glaucoma management in the elderly. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1190643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Anterior Chamber Angle Assessment by Anterior-segment Optical Coherence Tomography After Phacoemulsification With or Without Goniosynechialysis in Patients With Primary Angle Closure Glaucoma. J Glaucoma 2016; 24:647-55. [PMID: 24844542 DOI: 10.1097/ijg.0000000000000061] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate changes of anterior chamber angle (ACA) by anterior-segment optical coherence tomography (AS-OCT) in patients with primary angle closure glaucoma (PACG) following phacoemulsification (phaco) with or without goniosynechialysis (GSL). METHODS Patients with PACG recruited into 2 randomized controlled trials comparing phaco-GSL versus phaco were pooled for analysis. Images of ACA were obtained by AS-OCT before surgery, and at 1 and 2 weeks, and 1, 3, and 6 months after surgery. The following parameters were analyzed: angle opening distance (AOD) at 500 and 750 μm from the scleral spur, trabecular-iris space area (TISA) at 500 and 750 μm, angle recess area (ARA) at 500 and 750 μm, and scleral spur angle (SSA). RESULTS All parameters of ACA increased significantly after phaco-GSL (P<0.001), whereas no increase occurred in the phaco group. Negatively significant correlations were found in ΔAOD500 (P<0.05), ΔARA750 (P<0.05), ΔTISA500 (P<0.05), and ΔTISA750 (P<0.05) at 1, 3, and 6 months, and ΔSSA (P<0.05) at 3 and 6 months after phaco-GSL against Δ intraocular pressure (IOP). In the phaco-GSL group, 23 of 23 eyes had IOP<21 mm Hg without any antiglaucoma medication postoperatively. In the phaco group, 12 of 20 eyes (60%) had IOP<21 mm Hg without medication, 8 of 20 eyes required medication with IOP<21 mm Hg (15%) and uncontrollable IOP (25%) after surgery. CONCLUSIONS On AS-OCT evaluation, ACA in eyes with PACG opened and widened significantly after phaco-GSL in our study. It is suggested that ΔAOD500, ΔARA750, ΔTISA500, ΔTISA750, and ΔSSA would provide valuable information to estimate the effectiveness of phaco-GSL.
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Lee B. Imaging in glaucoma care pathways in the UK. J Vis Commun Med 2016; 39:33-9. [DOI: 10.1080/17453054.2016.1182139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Risk Factors of Disease Progression After Cataract Surgery in Chronic Angle-closure Glaucoma Patients. J Glaucoma 2016; 25:e372-6. [DOI: 10.1097/ijg.0000000000000350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baig N, Kam KW, Tham CCY. Managing Primary Angle Closure Glaucoma - The Role of Lens Extraction in this Era. Open Ophthalmol J 2016; 10:86-93. [PMID: 27014390 PMCID: PMC4780513 DOI: 10.2174/1874364101610010086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 11/24/2022] Open
Abstract
Trabeculectomy has been the gold standard in reducing intraocular pressure (IOP) in glaucoma patients, no matter it is angle closure or open angle glaucoma. However in primary angle closure glaucoma, no matter the lens is cataractous or not, it is likely to be pathological, this thicker than usual lens, with or without a more anterior position, is often regarded as a strong contributing factor to angle closure. Lens extraction, no matter it is cataractous or clear, can theoretically eliminate this anatomical predisposing factor of angle closure, and thus IOP can be reduced. Based on recent results of a number of clinical trials, lens extraction alone or in combination with other IOP-lowering surgeries, may therefore play a more important role in the treating primary angle closure glaucoma. In cases when greater IOP-lowering effect is needed or if drug dependency has to be minimized, combined procedures, such as phacotrabeculectomy, can be considered, but the surgical risk can be higher than lens extraction alone.
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Affiliation(s)
- Nafees Baig
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China; Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, People's Republic of China
| | - Ka-Wai Kam
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China; Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, People's Republic of China
| | - Clement C Y Tham
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China; Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, People's Republic of China
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Abstract
Primary angle-closure glaucoma (PACG) is a progressive optic nerve degeneration and is defined as a glaucomatous optic neuropathy with associated characteristic enlargement of optic disc cupping and visual field loss that is secondary to ocular hypertension caused by closure of the drainage angle. Angle closure is caused by appositional approximation or adhesion between the iris and the trabecular meshwork. The main treatment strategy for PACG lies in the reduction of intraocular pressure, reopening of the closed angle, and possible prevention of further angle closure. There is no universally agreed best surgical treatment for PACG. Trabeculectomy, goniosynechialysis (GSL), glaucoma implant, and cyclodestructive procedures are effective surgical options. Each of them plays an important role in the management of PACG with its own pros and cons. Accumulating evidence is available to show the effectiveness of visually significant and visually nonsignificant cataract extraction in the treatment of PACG. Trabeculectomy and GSL are often combined with cataract extraction, which may offer additional pressure control benefits to patients with PACG. This review article will discuss laser peripheral iridotomy, argon laser peripheral iridoplasty, and surgeries such as GSL, phacoemulsification, and phaco plus glaucoma surgeries that lower intraocular pressure and also alter the anterior segment and/or drainage angle anatomy. Currently, glaucoma implants and cyclodestruction are mainly reserved for PACG patients who have failed previous filtering operations. Their role as initial surgical treatment for PACG will not be discussed.
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Affiliation(s)
- Jimmy Lai
- From the Department of Ophthalmology, The University of Hong Kong, Hong Kong, China
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Lee CH, You IC, Kim YR. Phacoemulsification versus Laser Peripheral Iridotomy in Early Treatment of Acute Primary Angle-Closure Glaucoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.2.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Chang Hoon Lee
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
| | - In Cheon You
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
| | - You Ra Kim
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
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70
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Tham CC. January consultation #3. J Cataract Refract Surg 2016; 42:174-5; discussion 178-9. [DOI: 10.1016/j.jcrs.2016.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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71
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Li SW, Chen Y, Wu Q, Lu B, Wang WQ, Fang J. Angle parameter changes of phacoemulsification and combined phacotrabeculectomy for acute primary angle closure. Int J Ophthalmol 2015; 8:742-7. [PMID: 26309873 DOI: 10.3980/j.issn.2222-3959.2015.04.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/17/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To evaluate the difference in angle parameters and clinical outcome following phacoemulsification and combined phacotrabeculectomy in patients with acute primary angle closure (APAC) using ultrasound biomicroscopy (UBM). METHODS Patients (n=23, 31 eyes) were randomized to receive phacoemulsification or combined phacotrabeculectomy (n=24, 31 eyes). Best-corrected visual acuity (BCVA), intraocular pressure (IOP), the main complications following surgery, and indentation gonioscopy and angle parameters measured using UBM were documented preoperatively and postoperatively. RESULTS The improvement in BCVA in the phacoemulsification group was significantly greater than in the combined group (P<0.05). IOP in the phacoemulsification group was slightly higher than in the combined group following 1wk of follow-up (P<0.05), whereas there was no significant difference between the two groups at the latter follow-up (P>0.05). Phacoemulsification alone resulted in a slight increase in the trabecular ciliary processes distance compared with the combined surgery (P<0.05), whereas the other angle parameters showed no significant difference between the groups. Complications in combined group were greater than phacoemulsification only group. CONCLUSION Both surgeries effectively opened the drainage angle and deepened the anterior chamber, and IOP was well controlled postoperatively. However, phacoemulsification showed better efficacy in improving visual function and showed reduced complications following surgery.
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Affiliation(s)
- Shi-Wei Li
- Department of Ophthalmology, the Sixth People's Hospital Affiliated of Shanghai Jiaotong University, Shanghai 200233, China
| | - Yan Chen
- Department of Ophthalmology, the Sixth People's Hospital Affiliated of Shanghai Jiaotong University, Shanghai 200233, China
| | - Qiang Wu
- Department of Ophthalmology, the Sixth People's Hospital Affiliated of Shanghai Jiaotong University, Shanghai 200233, China
| | - Bin Lu
- Department of Ophthalmology, the Sixth People's Hospital Affiliated of Shanghai Jiaotong University, Shanghai 200233, China
| | - Wen-Qing Wang
- Department of Ophthalmology, the Sixth People's Hospital Affiliated of Shanghai Jiaotong University, Shanghai 200233, China
| | - Jian Fang
- Department of Ophthalmology, the Sixth People's Hospital Affiliated of Shanghai Jiaotong University, Shanghai 200233, China
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72
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Chen PP, Lin SC, Junk AK, Radhakrishnan S, Singh K, Chen TC. The Effect of Phacoemulsification on Intraocular Pressure in Glaucoma Patients. Ophthalmology 2015; 122:1294-307. [DOI: 10.1016/j.ophtha.2015.03.021] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022] Open
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The role of lens extraction in the current management of primary angle-closure glaucoma. Curr Opin Ophthalmol 2015; 26:128-34. [PMID: 25565368 DOI: 10.1097/icu.0000000000000128] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Lens extraction for primary angle-closure glaucoma (PACG) is a subject of increased interest recently, with advocates promoting its benefits of anatomical opening of the angle, intraocular pressure (IOP) reduction and improved vision. The present review seeks to evaluate recent available evidence to provide clarity on this potential intervention within the armamentarium of approaches for PACG. RECENT FINDINGS The emergence of recent case-control studies, cohort studies and randomized controlled trials has provided a stronger evidence base to equip ophthalmic surgeons with the necessary information to utilize lens extraction in the management of PACG, and to consider whether this should be combined with trabeculectomy or goniosynechialysis. Imaging modalities such as anterior segment optical coherence tomography have yielded new insights into the mechanical features of the lens in angle closure, with the lens thickness and lens vault now quantifiable. A trend is emerging regarding the improvement in IOP control, reduced complication rates and reduced need for IOP-lowering medications in patients who undergo lens extraction for PACG. These issues are discussed, along with aspects of preoperative assessment and surgical techniques. SUMMARY Good outcomes in terms of long-term IOP control have been found following lens extraction for PACG. Lens extraction should be considered in patients with PACG, especially with hyperopia, or a thick and anteriorly vaulted lens.
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74
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Melancia D, Abegão Pinto L, Marques-Neves C. Cataract surgery and intraocular pressure. Ophthalmic Res 2015; 53:141-8. [PMID: 25765255 DOI: 10.1159/000377635] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/02/2015] [Indexed: 11/19/2022]
Abstract
Cataract surgery is one of the most performed surgeries in the developed world. In addition to its significant impact on visual acuity, phacoemulsification has been hailed as a potential intraocular pressure (IOP)-lowering procedure. While current evidence suggests an overall significant and sustained decrease in IOP to exist after cataract surgery, the specific ocular characteristics that could help predict which patients are likely to benefit from this IOP-lowering effect remain unclear. This definition is important in glaucoma patients if this surgery is to be used in the treatment for this disease. Our review aims to summarize the literature on the subject, depicting possible mechanisms behind this IOP decrease, which type of patients are more likely to benefit from this surgery for IOP-lowering purposes and ultimately help optimizing disease management for the increasing number of patients with concomitant glaucoma and cataract.
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Affiliation(s)
- Diana Melancia
- Department of Pharmacology and Neurosciences, Lisbon University, Lisbon, Portugal
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75
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Muñoz-Negrete FJ, González-Martín-Moro J, Casas-Llera P, Urcelay-Segura JL, Rebolleda G, Ussa F, Güerri Monclús N, Méndez Hernández C, Moreno-Montañés J, Villegas Pérez MP, Pablo LE, García-Feijoó J. Guidelines for treatment of chronic primary angle-closure glaucoma. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2015; 90:119-138. [PMID: 25459683 DOI: 10.1016/j.oftal.2014.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 09/30/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To present a clinical practice guideline update on the medical, laser, and surgical treatment of primary angle closure glaucoma (PACG) in adults. METHODS Following the formulation of key questions using the PICO scheme (Patient/Problem, Intervention, Comparison, Outcome), a systematic review was performed on the literature published to date, including international clinical practice guidelines. The AMSTAR and Risk of Bias tools were used for evaluating the quality of the information. The level of evidence and grade of recommendation was established following the Scottish Intercollegiate Guidelines Network (SIGN) system. RESULTS Following the above methodology, recommendations of medical, laser and surgical treatment in adult PACG and levels of evidence are presented. CONCLUSIONS Although the level of scientific evidence for many of the questions raised is not very high, a review is presented on updated treatment recommendations for adult PACG. Among the limitations for the implementation of these recommendations is that most studies have been conducted in Asian populations, and that the effectiveness is measured almost exclusively in terms of reducing intraocular pressure, and does not include visual function, quality of life or cost-effectiveness parameters.
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Affiliation(s)
- F J Muñoz-Negrete
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, OFTARED, Alcalá de Henares, Madrid, España.
| | - J González-Martín-Moro
- Servicio de Oftalmología, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Coslada, Madrid, España
| | - P Casas-Llera
- Vissum Corporación-Instituto Oftalmológico de Alicante, OFTARED, Alicante, España
| | - J L Urcelay-Segura
- Servicio de Oftalmología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - G Rebolleda
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, OFTARED, Alcalá de Henares, Madrid, España
| | - F Ussa
- IOBA, Universidad de Valladolid, OFTARED, Valladolid, España
| | - N Güerri Monclús
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, IISA, Universidad de Zaragoza, OFTARED, Zaragoza, España
| | - C Méndez Hernández
- Servicio de Oftalmología HCSC, Instituto de Investigación Sanitaria HCSC (IdISSC), Universidad Complutense, OFTARED, Madrid, España
| | - J Moreno-Montañés
- Clínica Universidad de Navarra, Facultad de Medicina, OFTARED, Pamplona, España
| | - M P Villegas Pérez
- Departamento de Oftalmología, Facultad de Medicina, Universidad de Murcia; Hospital General Universitario Reina Sofía, IMIB-Arrixaca, OFTARED, Murcia, España
| | - L E Pablo
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, IISA, Universidad de Zaragoza, OFTARED, Zaragoza, España
| | - J García-Feijoó
- Servicio de Oftalmología HCSC, Instituto de Investigación Sanitaria HCSC (IdISSC), Universidad Complutense, OFTARED, Madrid, España
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Tun TA, Baskaran M, Perera SA, Htoon HM, Aung T, Husain R. Swept-source optical coherence tomography assessment of iris–trabecular contact after phacoemulsification with or without goniosynechialysis in eyes with primary angle closure glaucoma. Br J Ophthalmol 2015; 99:927-31. [DOI: 10.1136/bjophthalmol-2014-306223] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 12/21/2014] [Indexed: 11/04/2022]
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77
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Nasr A, Shalaby A, El Ghoniemy A. Goniosynechialysis versus phacotrabeculectomy in the management of coexisting cataract and primary angle-closure glaucoma. JOURNAL OF THE EGYPTIAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.4103/2090-0686.174679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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78
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Phacoemulsification Versus Combined Phacoemulsification and Viscogonioplasty in Primary Angle-Closure Glaucoma. J Glaucoma 2015; 24:575-82. [DOI: 10.1097/ijg.0000000000000196] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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79
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Cho SH, Kee CW. Combined Phacoemulsification, Synechiolysis without Gonioprism Lens and Intracameral Tissue Plasminogen Activator Injection for Angle-Closure Glaucoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.6.931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seok Ho Cho
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang Won Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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80
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Poon LYC, Lai IC, Lee JJ, Tsai JC, Lin PW, Teng MC. Comparison of surgical outcomes after phacotrabeculectomy in primary angle-closure glaucoma versus primary open-angle glaucoma. Taiwan J Ophthalmol 2015; 5:28-32. [PMID: 29018661 PMCID: PMC5602719 DOI: 10.1016/j.tjo.2015.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/18/2014] [Accepted: 01/07/2015] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare postoperative outcomes and assess factors associated with intraocular pressure (IOP) reduction after phacotrabeculectomy in patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). METHODS This is a retrospective study of patients who underwent phacotrabeculectomy between 2010 and 2013. Factors including age, gender, visual field (VF), the number of glaucoma medications used, biometric changes, IOP, and surgical success rates were compared between groups. RESULTS There were 27 PACG and 34 POAG patients. The PACG group had a greater mean IOP reduction after phacotrabeculectomy compared to the POAG group (5.5 ± 7.9 mmHg versus 2.0 ± 4.2 mmHg; p = 0.03). However, the final mean IOP was similar between the two groups (PACG: 12.2 ± 4.8 mmHg, POAG: 12.3 ± 3.1 mmHg; p = 0.92). Phacotrabeculectomy resulted in a mean decrease in axial length (AL) of 0.16 ± 0.15 mm in PACG and 0.16 ± 0.11 mm in POAG (p = 0.96), and an increase in anterior chamber depth (ACD) of 1.41 ± 0.91 mm in PACG, and 0.87 ± 0.86 mm in POAG (p = 0.04). At 2 years follow-up, the cumulative success rate of phacotrabeculectomy was 74% in PACG and 62% in POAG. Multivariate analysis found that early glaucoma stage, greater postoperative increase in ACD, and high preoperative IOP were factors associated with greater IOP reduction. CONCLUSION Postoperative success rates and mean IOP on the final visit after phacotrabeculectomy were similar between the PACG and POAG groups. Factors associated with IOP reduction were greater postoperative increase in ACD, and high preoperative IOP.
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Affiliation(s)
- Linda Yi-Chieh Poon
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ing-Chou Lai
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jong-Jer Lee
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jen-Chia Tsai
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pei-Wen Lin
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mei-Chin Teng
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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81
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Tham CCY, Leung DYL, Kwong YYY, Liang Y, Peng AY, Li FCH, Lai JSM, Lam DSC. Factors correlating with failure to control intraocular pressure in primary angle-closure glaucoma eyes with coexisting cataract treated by phacoemulsification or combined phacotrabeculectomy. Asia Pac J Ophthalmol (Phila) 2015; 4:56-9. [PMID: 26068613 DOI: 10.1097/apo.0000000000000091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To identify clinical factors correlating with failure to control intraocular pressure (IOP) in primary angle-closure glaucoma (PACG) eyes with cataract after phacoemulsification or phacotrabeculectomy. DESIGN Retrospective analysis of two prospective randomized controlled clinical trials. METHODS Primary angle-closure glaucoma eyes with cataract received phacoemulsification or phacotrabeculectomy. Failure was defined as having IOP of 21mm Hg or greater, or requiring glaucoma drugs to maintain an IOP of less than 21 mm Hg, or having had additional IOP-lowering surgery. Factors correlating with failure at 24 months after surgery were identified using logistic regression model. RESULTS One hundred twenty-three PACG eyes with cataract and receiving phacoemulsification (n = 62) and phacotrabeculectomy (n = 61) were analyzed. With univariate analysis, factors associated with failure included a higher preoperative IOP, a higher preoperative requirement for glaucoma drugs, absence of plateau iris configuration, and phacoemulsification alone. With multivariate analysis, factors associated with failure included a higher preoperative IOP [odds ratio (OR), 1.732 per increase in IOP of 5 mm Hg], a higher preoperative requirement for glaucoma drugs (OR, 1.913), and performance of phacoemulsification alone (OR, 10.24). CONCLUSIONS In PACG eyes with cataract, higher preoperative IOP and increased requirement for glaucoma drugs correlate with failure to control IOP after phacoemulsification or phacotrabeculectomy. Phacotrabeculectomy is more likely than phacoemulsification to achieve IOP control.
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Affiliation(s)
- Clement C Y Tham
- From the *Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong; †Hong Kong Eye Hospital, Kowloon; ‡Prince of Wales Hospital, Shatin; and §Department of Ophthalmology, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong SAR, People's Republic of China
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82
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Skalicky SE, Martin KR, Fenwick E, Crowston JG, Goldberg I, McCluskey P. Cataract and quality of life in patients with glaucoma. Clin Exp Ophthalmol 2014; 43:335-41. [DOI: 10.1111/ceo.12454] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 09/28/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Simon E Skalicky
- Discipline of Ophthalmology; University of Sydney; Sydney New South Wales Australia
- Centre for Eye Research Australia; University of Melbourne; Melbourne Victoria Australia
- Department of Ophthalmology; Addenbrooke's Hospital; Cambridge UK
- Departments of Ophthalmology and Surgery; Royal Melbourne Hospital; University of Melbourne
| | - Keith R Martin
- Department of Ophthalmology; Addenbrooke's Hospital; Cambridge UK
- Cambridge NIHR Biomedical Research Centre; University of Cambridge; Cambridge UK
| | - Eva Fenwick
- Centre for Eye Research Australia; University of Melbourne; Melbourne Victoria Australia
| | - Jonathan G Crowston
- Centre for Eye Research Australia; University of Melbourne; Melbourne Victoria Australia
| | - Ivan Goldberg
- Discipline of Ophthalmology; University of Sydney; Sydney New South Wales Australia
- Eye Associates; Sydney New South Wales Australia
- Sydney Eye Hospital; Sydney New South Wales Australia
| | - Peter McCluskey
- Discipline of Ophthalmology; University of Sydney; Sydney New South Wales Australia
- Sydney Eye Hospital; Sydney New South Wales Australia
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83
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Brown RH, Zhong L, Whitman AL, Lynch MG, Kilgo PD, Hovis KL. Reduced intraocular pressure after cataract surgery in patients with narrow angles and chronic angle-closure glaucoma. J Cataract Refract Surg 2014; 40:1610-4. [PMID: 25134991 DOI: 10.1016/j.jcrs.2014.01.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 01/09/2014] [Accepted: 01/16/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the effect of cataract surgery on intraocular pressure (IOP) in patients with narrow angles and chronic angle-closure glaucoma (ACG) and to determine whether the change in IOP was correlated with the preoperative pressure, axial length (AL), and anterior chamber depth (ACD). SETTING Private practice, Atlanta, Georgia, USA. DESIGN Retrospective case series. METHODS Charts of patients with narrow angles or chronic ACG who had cataract surgery were reviewed. All eyes had previous laser iridotomies. Data recorded included preoperative and postoperative IOP, AL, and ACD. The preoperative IOP was used to stratify eyes into 4 groups. RESULTS The charts of 56 patients (83 eyes) were reviewed. The mean reduction IOP in all eyes was 3.28 mm Hg (18%), with 88% having a decrease in IOP. There was a significant correlation between preoperative IOP and the magnitude of IOP reduction (r = 0.68, P < .001). The mean decrease in IOP was 5.3 mm Hg in eyes with a preoperative IOP above 20 mm Hg, 4.6 mm Hg in the over 18 to 20 mm Hg group, 2.5 mm Hg in the over 15 to 18 mm Hg group, and 1.4 mm Hg in the 15 mm Hg or less group. The mean follow-up was 3.0 years ± 2.3 (SD). CONCLUSIONS Cataract surgery reduced IOP in patients with narrow angles and chronic ACG. The magnitude of reduction was highly correlated with preoperative IOP and weakly correlated with ACD. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Reay H Brown
- From Atlanta Ophthalmology Associates (Brown), Emory University (Whitman, Kilgo), and the Department of Veterans Affairs (Lynch), Emory Eye Center/Emory University School of Medicine, Atlanta, Georgia; the University of Miami Miller School of Medicine (Zhong), Miami, Florida; Vanderbilt University School of Medicine (Hovis), Nashville, Tennessee, USA.
| | - Le Zhong
- From Atlanta Ophthalmology Associates (Brown), Emory University (Whitman, Kilgo), and the Department of Veterans Affairs (Lynch), Emory Eye Center/Emory University School of Medicine, Atlanta, Georgia; the University of Miami Miller School of Medicine (Zhong), Miami, Florida; Vanderbilt University School of Medicine (Hovis), Nashville, Tennessee, USA
| | - Allison L Whitman
- From Atlanta Ophthalmology Associates (Brown), Emory University (Whitman, Kilgo), and the Department of Veterans Affairs (Lynch), Emory Eye Center/Emory University School of Medicine, Atlanta, Georgia; the University of Miami Miller School of Medicine (Zhong), Miami, Florida; Vanderbilt University School of Medicine (Hovis), Nashville, Tennessee, USA
| | - Mary G Lynch
- From Atlanta Ophthalmology Associates (Brown), Emory University (Whitman, Kilgo), and the Department of Veterans Affairs (Lynch), Emory Eye Center/Emory University School of Medicine, Atlanta, Georgia; the University of Miami Miller School of Medicine (Zhong), Miami, Florida; Vanderbilt University School of Medicine (Hovis), Nashville, Tennessee, USA
| | - Patrick D Kilgo
- From Atlanta Ophthalmology Associates (Brown), Emory University (Whitman, Kilgo), and the Department of Veterans Affairs (Lynch), Emory Eye Center/Emory University School of Medicine, Atlanta, Georgia; the University of Miami Miller School of Medicine (Zhong), Miami, Florida; Vanderbilt University School of Medicine (Hovis), Nashville, Tennessee, USA
| | - Kristen L Hovis
- From Atlanta Ophthalmology Associates (Brown), Emory University (Whitman, Kilgo), and the Department of Veterans Affairs (Lynch), Emory Eye Center/Emory University School of Medicine, Atlanta, Georgia; the University of Miami Miller School of Medicine (Zhong), Miami, Florida; Vanderbilt University School of Medicine (Hovis), Nashville, Tennessee, USA
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84
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Lens-based glaucoma surgery: Using cataract surgery to reduce intraocular pressure. J Cataract Refract Surg 2014; 40:1255-62. [DOI: 10.1016/j.jcrs.2014.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 01/13/2014] [Indexed: 11/19/2022]
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85
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Tojo N, Otsuka M, Miyakoshi A, Fujita K, Hayashi A. Improvement of fluctuations of intraocular pressure after cataract surgery in primary angle closure glaucoma patients. Graefes Arch Clin Exp Ophthalmol 2014; 252:1463-8. [DOI: 10.1007/s00417-014-2666-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/29/2014] [Accepted: 05/06/2014] [Indexed: 11/30/2022] Open
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86
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Phacoemulsification versus peripheral iridotomy in the management of chronic primary angle closure: long-term follow-up. Int Ophthalmol 2014; 35:173-8. [PMID: 24728533 DOI: 10.1007/s10792-014-9926-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
Primary angle closure occurs as a result of crowded anterior segment anatomy, causing appositional contact between the peripheral iris and trabecular meshwork, thereby obstructing aqueous outflow. Several studies highlight the role of the crystalline lens in its pathogenesis. The objective of this work is to compare the long-term efficacy of phacoemulsification versus laser peripheral iridotomy (LPI) in the management of chronic primary angle closure (CPAC). Prospective case-control study with 30 eyes of 30 patients randomly divided in two groups: 15 eyes in the LPI group and 15 eyes in the IOL group. Patients in the LPI group underwent LPI using argon and Nd:YAG laser. Patients in the IOL group underwent phacoemulsification with posterior chamber intraocular lens (IOL) implantation. Examinations before and after the procedure included gonioscopy, Goldmann applanation tonometry, and anterior chamber evaluation using the Pentacam rotating Scheimpflug camera. The mean follow-up time was 31.13 ± 4.97 months. There was a statistically significant reduction in the intraocular pressure (IOP) and number of anti-glaucoma medications (p < 0.01) only in the IOL group. Anterior chamber depth, angle, and volume were all higher in the IOL group (p < 0.01) at the end of the follow-up period. Phacoemulsification with posterior chamber IOL implantation results in a higher anterior chamber depth, angle, and volume, when compared to LPI. Consequently, phacoemulsification has greater efficacy in lowering IOP and preventing its long-term increase in patients with CPAC and cataract.
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Lee HS, Park JW, Park SW. Factors affecting refractive outcome after cataract surgery in patients with a history of acute primary angle closure. Jpn J Ophthalmol 2013; 58:33-9. [PMID: 24162763 DOI: 10.1007/s10384-013-0285-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 09/20/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE This study was conducted to evaluate the influence of preoperative or intraoperative factors on the refractive outcome after cataract surgery in patients with a history of acute primary angle closure (APAC). METHODS Eyes were divided into two groups: those with stable refractive outcome and those with unstable refractive outcome at 8 weeks after uneventful cataract surgery. Univariate and multivariate regression analyses were performed to investigate factors associated with the postoperative refractive outcome. RESULTS Fifty-three eyes of 53 patients with a history of APAC (21 eyes with stable refractive outcome, 32 eyes with unstable refractive outcome) were enrolled. In the univariate regression analysis, longer duration of APAC [odds ratio (OR) 1.328; 95 % confidence interval (CI) 1.137-1.552; P = 0.001] and poor preoperative best corrected visual acuity (OR 4.648; 95 % CI 1.071-20.168; P = 0.040) were associated with unstable refractive outcome after cataract surgery in patients with a history of APAC. In the multivariate regression analysis, the duration of APAC was the only independent factor predicting refractive outcome after cataract surgery in patients with a history of APAC (OR 1.317; 95 % CI 1.113-1.558; P = 0.001). CONCLUSIONS Normalization of elevated intraocular pressure as soon as possible after APAC onset is recommended to obtain a stable refractive outcome after cataract surgery in patients with a history of APAC.
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Affiliation(s)
- Hyo Seok Lee
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, 8 Hak-Dong, Dong-Gu, Gwangju, 501-757, Republic of Korea
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90
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Lai JSM. The Role of Goniosynechialysis in the Management of Chronic Angle-Closure Glaucoma. Asia Pac J Ophthalmol (Phila) 2013; 2:277-8. [PMID: 26107027 DOI: 10.1097/apo.0b013e3182a8146b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jimmy S M Lai
- From the Department of Ophthalmology, Department of Ophthalmology, The University of Hong Kong Hong Kong, People's Republic of China
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91
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Zhao XJ, Yang XX, Fan YP, Li BH, Li Q. Comparison of Combined Phacoemulsification, Intraocular Lens Implantation, and Goniosynechialysis With Phacotrabeculectomy in the Treatment of Primary Angle-Closure Glaucoma and Cataract. Asia Pac J Ophthalmol (Phila) 2013; 2:286-90. [PMID: 26107030 DOI: 10.1097/apo.0b013e318299df62] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study aimed to compare the efficacy and safety of combined phacoemulsification, intraocular lens implantation, and goniosynechialysis with phacotrabeculectomy in the treatment of primary angle-closure glaucoma (PACG) and cataract. DESIGN A comparative case series. METHODS Sixty-five patients (65 eyes) with PACG and cataract from the Fifth Affiliated Hospital of Sun Yat-Sen University were enrolled for this study between October 2009 and July 2011. Of these, 33 underwent combined phacoemulsification, intraocular lens implantation, and goniosynechialysis (treatment group), and 32 underwent phacotrabeculectomy (control group). The effects on intraocular pressure, best-corrected visual acuity, anterior chamber angle, number of antiglaucoma medications, and complications were evaluated. RESULTS Both the treatment group and the control group had lowered intraocular pressure, reduced the use of antiglaucoma medications, and improved vision in patients with PACG and cataract. Complications were 8 (24.2%) of 33 in the treatment group and 12 (37.5%) of 32 in the control group. CONCLUSIONS Combined phacoemulsification, intraocular lens implantation, and goniosynechialysis appears to be a preferred method for the treatment of PACG and cataract because it seems to have the same efficacy as phacotrabeculectomy and has much less surgical complications.
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Affiliation(s)
- Xiao-Jing Zhao
- From the Departments of *Ophthalmology, and †Otolaryngology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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92
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Anterior lens capsule application in phacotrabeculectomy. J Glaucoma 2013; 22:e16. [PMID: 23872621 DOI: 10.1097/ijg.0b013e3182a1a527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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93
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White AJR, Orros JMA, Healey PR. Outcomes of combined lens extraction and goniosynechialysis in angle closure. Clin Exp Ophthalmol 2013; 41:746-52. [PMID: 23601286 DOI: 10.1111/ceo.12121] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 03/14/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to assess the effect of goniosynechialysis on intraocular pressure and medication requirement in patients with angle closure. DESIGN A retrospective chart review. PARTICIPANTS 51 eyes from 42 patients were included in the study. 17 had documented evidence of acute angle closure while 34 had chronic angle closure. METHODS Examination of the medical records of patients with synechial primary angle closure who underwent combined phacoemulsification and goniosynechialysis from 2003-2011 at 3 centres. MAIN OUTCOME MEASURES Intraocular pressure and requirement for drops were the main outcome measures. RESULTS Mean follow-up was 25.9 months for the acute group and 25.4 months for the chronic group. Mean preoperative intraocular pressure was 23.33 ± 14.41 mmHg on an average of 2.51 ± 1.3 medications. Mean postoperative intraocular pressure was lowered to 13.67 ± 2.41 (p ≤ 0.01) and medication usage was significantly lowered to 0.65 ± 0.87 (p ≤ 0.01). Subjects with documented acute symptomatic angle closure had higher preoperative intraocular pressure and a larger intraocular pressure fall post goniosynechialysis (from 30.41 mmHg ± 23 mmHg to 12.12 mmHg ± 2.32 mmHg) compared to those without such a documented episode (19.79 mmHg ± 4.37 mmHg to 14.44 mmHg ± 2.08 mmHg, p = 0.007). Both groups have similar postoperative need for glaucoma medication, 0.65 ± 0.93 vs 0.65 ± 0.85. CONCLUSIONS Combined phacoemulsififcation and goniosynechialysis reduces intraocular pressure, medication requirements and need for further surgery in subjects with angle closure. The procedure is more effective in eyes with a previously documented acute symptomatic presentation of angle closure.
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Affiliation(s)
- Andrew J R White
- Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, NSW, Australia
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94
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Chen J, Zou YP. Endoscope-assisted goniosynechialysis combined with phacoemulsification and intraocular lens implantation to manage primary angle-closure glaucoma. Int J Ophthalmol 2013; 6:174-7. [PMID: 23638419 DOI: 10.3980/j.issn.2222-3959.2013.02.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 02/20/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To describe and evaluate a new ophthalmic endoscope surgical technique combined with phacoemulsification and intraocular lens (IOL) implantation to treat goniosynechialysis and manage primary angle-closure glaucoma (PACG). METHODS Endoscope-assisted goniosynechialysis combined with phacoemulsification and IOL implantation was performed in 32 eyes of 29 patients with PACG. Regular follow-up was performed 1 week and 1 month, 3, and 6 months after surgery to assess complications, intraocular pressure (IOP), anterior chamber depth, visual acuity, and anterior chamber angle. RESULTS Preoperative mean IOP was 24.88±7.22mmHg with pharmacological treatment, and was 13.70±4.02, 13.06±3.74, 14.29±4.70, and 14.33±5.01mmHg 1 week, 1 month, 3 months, and 6 months after surgery, respectively. The postoperative decrease in IOP was significant (P<0.05). The rate for all eyes with IOP of 21mmHg or less was 93.8% (30 eyes) at the final visit without ocular hypotensive agents. The average preoperative anterior chamber depth was 1.60±0.64mm, and this value significantly increased to 2.72±0.62, 2.76±0.70, 2.73±0.68, and 2.74±0.71mm at 1 week, 1 month, 3 months, and 6 months, respectively. Visual acuity was improved in 28 eyes (87.5%) at 6 months postoperatively. The anterior chamber angle had increased in 25 eyes (78.1%) at the final visit; it was adhesive 90°-180° in 6 eyes, 180°-270° in only 1 eye. Two eyes exhibited minimal hyphema in the early postoperative period, but it could gradually be absorbed. Fibrinous reaction was observed in five eyes and spontaneously disappeared within 7 days. No shallow anterior chamber, iridodialysis, choroidal detachment, or malignant glaucoma was found in any eyes. CONCLUSION Endoscope-assisted goniosynechialysis combined with phacoemulsification and IOL implantation to manage PACG has several advantages, including optimized visualization, greater accuracy, and improved safety. Our results suggest that it has certain curative effects and clinical application value.
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Affiliation(s)
- Jing Chen
- Department of Ophthalmology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, Guangdong Province, China
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95
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Choi WS, Shin YJ, Kim HK, Yi K. Comparison of Intraocular Pressure after Cataract Surgery According to Incisional Techniques. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.12.1856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Won Seok Choi
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Young Joo Shin
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ha Kyoung Kim
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kayoung Yi
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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96
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Lee RY, Kasuga T, Cui QN, Huang G, Wang SY, Lin SC. Ethnic differences in intraocular pressure reduction and changes in anterior segment biometric parameters following cataract surgery by phacoemulsification. Clin Exp Ophthalmol 2012; 41:442-9. [PMID: 23146132 DOI: 10.1111/ceo.12032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 10/27/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Roland Y Lee
- Department of Ophthalmology; University of California; San Francisco; California; USA
| | | | - Qi N Cui
- Department of Ophthalmology; University of California; San Francisco; California; USA
| | | | - Sophia Y Wang
- Department of Ophthalmology; University of California; San Francisco; California; USA
| | - Shan C Lin
- Department of Ophthalmology; University of California; San Francisco; California; USA
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97
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Rhiu S, Lee ES, Kim TI, Lee HS, Kim CY. Power prediction for one-piece and three-piece intraocular lens implantation after cataract surgery in patients with chronic angle-closure glaucoma: a prospective, randomized clinical trial. Acta Ophthalmol 2012; 90:e580-5. [PMID: 22971184 DOI: 10.1111/j.1755-3768.2012.02499.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the accuracy of intraocular lens (IOL) power prediction for cataract surgery in chronic angle-closure glaucoma (CACG) patients with different IOLs' implantation. METHODS This prospective randomized clinical trial included 45 eyes with CACG and 48 eyes with normal controls undergoing cataract surgery. In the CACG group, 23 eyes (51%) had three-piece IOL implantation and 22 eyes (49%) had one-piece IOL implantation. In the normal control group, 25 eyes (52%) had three-piece IOL implantation and 23 eyes (48%) had one-piece IOL implantation. Using the SRK/T formula, the mean difference between the predicted and actual postoperative spherical equivalent [mean absolute error (MAE)] was obtained and converted to natural logarithm (ln) for statistical analysis. The power of the implanted IOL was calculated to predict postoperative SE using three formulas: SRK II, Holladay II and Hoffer Q by post hoc analysis in each group. The predictive accuracy of each formula was analysed by comparing the lnMAE. RESULTS In the one-piece IOL group, there was no difference in lnMAE between the CACG and normal control group (p = 0.314). In the three-piece IOL group, the lnMAE of the CACG group was larger than that of the normal control group (p < 0.001). The lnMAEs calculated by the SRK/T formula were more accurate than the Holladay II (p = 0.045) and Hoffer Q (p = 0.042) formula in the CACG one-piece IOL group. CONCLUSIONS Implantation of one-piece IOLs provides similar power prediction accuracy comparable to normal cataract patients; this result may be explained by the IOL haptic configuration or design.
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Affiliation(s)
- Soolienah Rhiu
- Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea Seran Eye Center, Seoul, Korea
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98
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Liu XQ, Zhu HY, Su J, Hao XJ. Effects of phacoemulsification on intraocular pressure and anterior chamber depth. Exp Ther Med 2012; 5:507-510. [PMID: 23403825 PMCID: PMC3570164 DOI: 10.3892/etm.2012.835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 11/01/2012] [Indexed: 10/27/2022] Open
Abstract
The aim of this study was to investigate the effects of phacoemulsification with intraocular lens (IOL) implantation on intraocular pressure (IOP) and anterior chamber depth (ACD) in patients with cataract or cataract associated with primary angle closure (PAC). A total of 361 patients (481 affected eyes) with senile cataract (cataract group) and 44 patients (52 affected eyes) with cataract associated with PAC (cataract with PAC group) underwent phacoemulsification with IOL implantation from July 2005 to May 2007 and were followed up for 3 to 25 months. There was a significant difference between pre-operative and post-operative IOPs (t=9.270, P<0.01) in the cataract group and in the cataract with PAC group (t=3.29, P<0.01). No significant differences were identified in pre-operative IOP (t=-2.437, P>0.05) and the IOP three months after surgery (t=2.154, P>0.05) between the two groups. There was a significant difference between the pre-operative and post-operative ACDs (t=7.781, P<0.01) in the cataract group and in the cataract with PAC group (t=4.528, P<0.01). A significant difference in ACD between the two groups (t=8.325, P<0.01) existed prior to surgery but following surgery, the ACDs of the two groups were not significantly different (t=2.86, P>0.05). Phacoemulsification with IOL implantation has IOP-lowering effects on cataract and cataract with PAC patients. The International Society of Geography and Epidemiology of Ophthalmology classification method for angle closure glaucoma was adopted in our study. Furhter studies are required to prove the safety and mechanism of lowering IOP impact of phacoemulsifation towards PAC glaucoma (PACG).
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Affiliation(s)
- Xin-Quan Liu
- Affiliated Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P.R. China
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99
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Eslami Y, Latifi G, Moghimi S, Ghaffari R, Fakhraie G, Zarei R, Jabbarvand M, Mohammadi M, Lin S. Effect of adjunctive viscogonioplasty on drainage angle status in cataract surgery: a randomized clinical trial. Clin Exp Ophthalmol 2012; 41:368-78. [DOI: 10.1111/j.1442-9071.2012.02871.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 08/12/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Yadollah Eslami
- Farabi Eye Research Center; Tehran University of Medical Science; Tehran; Iran
| | - Golshan Latifi
- Farabi Eye Research Center; Tehran University of Medical Science; Tehran; Iran
| | - Sasan Moghimi
- Farabi Eye Research Center; Tehran University of Medical Science; Tehran; Iran
| | - Reza Ghaffari
- Farabi Eye Research Center; Tehran University of Medical Science; Tehran; Iran
| | - Ghasem Fakhraie
- Farabi Eye Research Center; Tehran University of Medical Science; Tehran; Iran
| | - Reza Zarei
- Farabi Eye Research Center; Tehran University of Medical Science; Tehran; Iran
| | - Mahmood Jabbarvand
- Farabi Eye Research Center; Tehran University of Medical Science; Tehran; Iran
| | - Massood Mohammadi
- Farabi Eye Research Center; Tehran University of Medical Science; Tehran; Iran
| | - Shan Lin
- Department of Ophthalmology; San Francisco School of Medicine; University of California; San Francisco; California; USA
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100
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Clinical Outcomes After Lens Extraction for Visually Significant Cataract in Eyes With Primary Angle Closure. J Glaucoma 2012; 21:545-50. [DOI: 10.1097/ijg.0b013e31821db1db] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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