1
|
Giglio R, Inferrera L, De Giacinto C, DʼAloisio R, Beccastrini A, Vinciguerra AL, Perrotta AA, Toro MD, Zweifel S, Tognetto D. Changes in Anterior Segment Morphology and Intraocular Pressure after Cataract Surgery in Non-glaucomatous Eyes. Klin Monbl Augenheilkd 2023; 240:449-455. [PMID: 37164442 DOI: 10.1055/a-2013-2374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND It is known that cataract extraction is associated with a significant reduction in intraocular pressure, especially in narrow angled eyes; however, the modifications of anterior segment parameters associated with this phenomenon have still not been completely defined. The purpose of this study was to evaluate changes in anterior segment anatomy and intraocular pressure after cataract surgery in non-glaucomatous eyes. METHODS AND MATERIAL This retrospective case series study included 64 eyes of 64 consecutive patients who underwent phacoemulsification with intraocular lens implantation. Anterior segment parameters and intraocular pressure were assessed and compared before and 6 months after surgery. Anterior segment imaging was performed using Casia SS-1000 anterior segment optical coherence tomography (Tomey, Nagoya, Japan). Anterior segment measurements included anterior chamber depth, anterior chamber width, anterior chamber volume, angle opening distance at 500 µm anterior to the scleral spur, angle recess area 750 µm from the scleral spur, lens vault, trabecular iris space area at 500 µm from the scleral spur, and trabecular iris angle at 500 µm from the scleral spur. Intraocular pressure was measured using the Goldmann applanation tonometer (Model AT 900 C/M, Haag-Streit, Bern, Switzerland). Anterior segment parameters and the relationship of changes in intraocular pressure were also evaluated. RESULTS All anterior segment parameters increased significantly after surgery (p < 0.05). Both angle opening distance at 500 µm anterior to the scleral spur and anterior chamber depth changes were positively correlated with the preoperative lens vault. The mean intraocular pressure significantly decreased from 14.91 mmHg (± 2.8 SD) to 12.91 mmHg (± 3.13 SD) (p < 0.001). Changes in intraocular pressure correlated negatively with values for the width of the preoperative anterior chamber (r = - 0.533; p = 0.001). CONCLUSION Cataract surgery led to significant widening of the anterior chamber angle and lowering of intraocular pressure. Further investigations are needed to better understand whether anterior chamber width may be a new independent predictive factor for reduction in postoperative intraocular pressure.
Collapse
Affiliation(s)
- Rosa Giglio
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Leandro Inferrera
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Chiara De Giacinto
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Rossella DʼAloisio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University "G. D'Annunzio" of Chieti Pescara, Chieti, Italy
| | - Andrea Beccastrini
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Alex Lucia Vinciguerra
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Alberto Armando Perrotta
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Mario Damiano Toro
- Eye Clinic, Department of Public Health, University of Naples Federico II, Napoli, Italy
- Chair and Department of General and Paediatric Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniele Tognetto
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| |
Collapse
|
2
|
Song WK, Sung KR, Kim KE. Assessment of Iridotrabecular Contact and Its Association With Intraocular Pressure After Phacoemulsification in Primary Angle Closure. Am J Ophthalmol 2022; 249:1-11. [PMID: 36586662 DOI: 10.1016/j.ajo.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the association between the quantitative assessment of iridotrabecular contact (ITC), measured by swept-source anterior segment optical coherence tomography (SS AS-OCT), and intraocular pressure (IOP) control after phacoemulsification in patients with primary angle closure disease (PACD). DESIGN Retrospective, clinical cohort study. METHODS Preoperative and postoperative anterior chamber angle parameters were measured using SS AS-OCT. IOP was measured preoperatively and until 6 months postoperatively. Percent IOP reduction and fluctuation after surgery were calculated, and their relationships with SS AS-OCT parameters were assessed by correlation analyses and locally weighted scatterplot smoothing (LOWESS) regression with change-point analysis. RESULTS A total of 51 eyes of 51 PACD patients were included. Preoperative ITC index and area (r = 0.626, r = 0.551), as well as changes in ITC index and area (r = 0.632, r = 0.543) after surgery, were significantly correlated with postoperative IOP reduction, after adjusting for age and gender (all P <.001). Higher postoperative ITC index (r = 0.405, P = .005) and ITC area (r = 0.460, P = 0.001) were associated with greater postoperative IOP fluctuations. Change points on LOWESS curves were observed for preoperative ITC index (33.0%) and change in ITC index (27.0%) and percent IOP reductions were significantly correlated with them above (β = 0.386, β = 0.664, all P < .001) but not below the change points. CONCLUSIONS Quantitative assessment of circumferential ITC can predict postoperative IOP control after phacoemulsification, and thus it may be used as a reference for determining lens extraction in PACD eyes.
Collapse
Affiliation(s)
- Woo Keun Song
- From the Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyung Rim Sung
- From the Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Ko Eun Kim
- From the Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
3
|
Abstract
BACKGROUND Primary angle-closure glaucoma (PACG) is characterized by a rise in intraocular pressure (IOP) secondary to aqueous outflow obstruction, with relative pupillary block being the most common underlying mechanism. There is increasing evidence that lens extraction may relieve pupillary block and thereby improve IOP control. As such, comparing the effectiveness of lens extraction against other commonly used treatment modalities can help inform the decision-making process. OBJECTIVES To assess the effectiveness of lens extraction compared with other interventions in the treatment of chronic PACG in people without previous acute angle-closure attacks. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, one other database, and two trials registers (December 2019). We also screened the reference lists of included studies and the Science Citation Index database. We had no date or language restrictions. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing lens extraction with other treatment modalities for chronic PACG. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology. MAIN RESULTS We identified eight RCTs with 914 eyes. We obtained data for participants meeting our inclusion criteria for these studies (PACG only, no previous acute angle-closure attacks), resulting in 513 eyes included in this review. The participants were recruited from a diverse range of countries. We were unable to conduct meta-analyses due to different follow-up periods and insufficient data. One study compared phacoemulsification with laser peripheral iridotomy (LPI) as standard care. Participants in the phacoemulsification group were less likely to experience progression of visual field loss (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.13 to 0.91; 216 eyes; moderate certainty evidence), and required fewer IOP-lowering medications (mean difference [MD] -0.70, 95% CI -0.89 to -0.51; 263 eyes; moderate certainty evidence) compared with standard care at 12 months. Moderate certainty evidence also suggested that phacoemulsification improved gonioscopic findings at 12 months or later (MD -84.93, 95% CI -131.25 to -38.61; 106 eyes). There was little to no difference in health-related quality of life measures (MD 0.04, 95% CI -0.16 to 0.24; 254 eyes; moderate certainty evidence), and visual acuity (VA) (MD 2.03 ETDRS letter, 95% CI -0.77 to 4.84; 242 eyes) at 12 months, and no observable difference in mean IOP (MD -0.03mmHg, 95% CI -2.34 to 2.32; 257 eyes; moderate certainty evidence) compared to standard care. Irreversible loss of vision was observed in one participant in the phacoemulsification group, and three participants in standard care at 36 months (moderate-certainty evidence). One study (91 eyes) compared phacoemulsification with phaco-viscogonioplasty (phaco-VGP). Low-certainty evidence suggested that fewer IOP-lowering medications were needed at 12 months with phacoemulsification (MD -0.30, 95% CI -0.55 to -0.05). Low-certainty evidence also suggested that phacoemulsification may have improved gonioscopic findings at 12 months or later compared to phaco-VGP (angle grading MD -0.60, 95% CI -0.91 to -0.29; TISA500 MD -0.03, 95% CI -0.06 to -0.01; TISA750 MD -0.03, 95% CI -0.06 to -0.01; 91 eyes). Phacoemulsification may result in little to no difference in best corrected VA at 12 months (MD -0.01 log MAR units, 95% CI -0.10 to 0.08; low certainty evidence), and the evidence is very uncertain about its effect on IOP at 12 months (MD 0.50 mmHg, 95% CI -2.64 to 3.64; very low certainty evidence). Postoperative fibrin reaction was observed in two participants in the phacoemulsification group and four in the phaco-VGP group. Three participants in the phaco-VGP group experienced hyphema. No data were available for progression of visual field loss and quality of life measurements at 12 months. Two studies compared phacoemulsification with phaco-goniosynechialysis (phaco-GSL). Low-certainty evidence suggested that there may be little to no difference in mean IOP at 12 months (MD -0.12 mmHg, 95% CI -4.72 to 4.48; 1 study, 32 eyes) between the interventions. Phacoemulsification did not reduce the number of IOP-lowering medications compared to phaco-GSL at 12 months (MD -0.38, 95% CI -1.23 to 0.47; 1 study, 32 eyes; moderate certainty evidence). Three eyes in the phaco-GSL group developed hyphemas. No data were available at 12 months for progression of visual field loss, gonioscopic findings, visual acuity, and quality of life measures. Three studies compared phacoemulsification with combined phaco-trabeculectomy, but the data were only available for one study (63 eyes). In this study, low-certainty evidence suggested that there was little to no difference between groups in mean change in IOP from baseline (MD -0.60 mmHg, 95% CI -1.99 to 0.79), number of IOP-lowering medications at 12 months (MD 0.00, 95% CI -0.42 to 0.42), and VA measured by the Snellen chart (MD -0.03, 95% CI -0.18 to 0.12). Participants in the phacoemulsification group had fewer complications (risk ratio [RR] 0.59, 95% CI 0.34 to 1.04), and the phaco-trabeculectomy group required more IOP-lowering procedures (RR 5.81, 95% CI 1.41 to 23.88), but the evidence was very uncertain. No data were available for other outcomes. AUTHORS' CONCLUSIONS Moderate certainty evidence showed that lens extraction has an advantage over LPI in treating chronic PACG with clear crystalline lenses over three years of follow-up; ultimately, the decision for intervention should be part of a shared decision-making process between the clinician and the patient. For people with chronic PACG and visually significant cataracts, low certainty evidence suggested that combining phacoemulsification with either viscogonioplasty or goniosynechialysis does not confer any additional benefit over phacoemulsification alone. There was insufficient evidence to draw any meaningful conclusions regarding phacoemulsification versus trabeculectomy. Low certainty evidence suggested that combining phacoemulsification with trabeculectomy does not confer any additional benefit over phacoemulsification alone, and may cause more complications instead. These conclusions only apply to short- to medium-term outcomes; studies with longer follow-up periods can help assess whether these effects persist in the long term.
Collapse
Affiliation(s)
- Ariel Yuhan Ong
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sueko M Ng
- Department of Ophthalmology, School of Medicine, University of Colorado, Aurora, CO, USA
| | | | - David S Friedman
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Costa VP, Leung CK, Kook MS, Lin SC, Al-Aswad LA, Araie M, Baudouin C, Coupal DJ, Fechtner R, Tee Khaw P, Khaderi KR, Khawaja A, Mattox C, Miller-Ellis E, Nagori S, Olivier M, Pfeiffer N, Serle J, Stalmans I, Varma DK. Clear lens extraction in eyes with primary angle closure and primary angle-closure glaucoma. Surv Ophthalmol 2020; 65:662-674. [DOI: 10.1016/j.survophthal.2020.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
|
5
|
Phaco-endocycloplasty versus Phacotrabeculectomy in Primary Angle-Closure Glaucoma: A Prospective Randomized Study. Ophthalmol Glaucoma 2020; 3:434-442. [PMID: 32771456 DOI: 10.1016/j.ogla.2020.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate the efficacy and safety of endocycloplasty (ECPL) versus trabeculectomy when it is combined with phacotrabeculectomy in medically controlled or uncontrolled primary angle-closure (PAC) or primary angle-closure glaucoma (PACG) after laser peripheral iridotomy (LPI). DESIGN Prospective, interventional, randomized control trial. PARTICIPANTS Subjects with PAC/PACG aged 30 years or more after LPI with visually significant cataract. METHODS Subjects underwent computer-generated randomized sequence of either procedure, phaco-ECPL or phacotrabeculectomy, for standard indications of combined glaucoma and cataract surgery. MAIN OUTCOME MEASURES Primary outcome measure was intraocular pressure (IOP). Secondary outcome measures were best-corrected visual acuity (BCVA), number of antiglaucoma medications (AGMs), complications, and failure. RESULTS A total of 45 eyes of 39 subjects were included. A total of 25 eyes underwent phaco-ECPL, and 20 eyes underwent phacotrabeculectomy. Five eyes in the phaco-ECPL group were excluded; 2 were excluded because laser was not delivered per protocol, and the rest had less than 3 months of follow-up. Mean follow-up was 16.25±8.1 months in the phaco-ECPL group and 18.9±9.5 months in the phacotrabeculectomy group. Mean preoperative and postoperative IOP, AGM, and BCVA did not differ between the groups. However, the rate of complications (P = 0.011) and interventions (P = 0.047) was greater in the phacotrabeculectomy group. CONCLUSIONS Both procedures are efficacious in lowering IOP in PACG, but the rate of complication and interventions for these were more in the phacotrabeculectomy group. Longer follow-up is indicated to probe the feasibility of phaco-ECPL, a minimally invasive procedure, as first-step management in PAC disease, for which combined cataract and glaucoma surgery is indicated.
Collapse
|
6
|
Vu AT, Bui VA, Vu HL, Quyet D, Thai TV, Nga VT, Dinh TC, Bac ND. Evaluation of Anterior Chamber Depth and Anterior Chamber Angle Changing After Phacoemulsification in the Primary Angle Close Suspect Eyes. Open Access Maced J Med Sci 2019; 7:4297-4300. [PMID: 32215081 PMCID: PMC7084008 DOI: 10.3889/oamjms.2019.378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: Phacoemulsification surgery has the ability to deeply alter the segment anterior morphology, especially in eye with shallow anterior chamber (AC), narrow anterior chamber angle (ACA). However, the changes of anterior chamber depth (ACD) and ACA on the close angle suspect eyes after phacoemulsification have not been mentioned in many studies. So, we conduct this research. AIM: To evaluate the alteration in the ACA and ACD after phacoemulsification in the close angle suspect eyes. METHODS: Interventional study with no control group. Subjects were the primary angle closure suspect (PACS) eyes, that were operated by phacoemulsification with intraocular lens (IOL) at Glaucoma Department of VNIO from December 2017 to October 2018. RESULTS: 29 PACS eyes with cataract were operated by phacoemulsification with intraocular lens. After 3 months of monitoring, the average ACD augmented from 2.082 ± 0.244 to 3.673 ± 0.222 mm. AOD500 increase from 0.183 ± 0.088 to 0.388 ± 0.132 μm, AOD750 increased from 0.278 ± 0.105 to 0.576 ± 0.149 μm. The TISA500 enlarged from 0.068 ± 0.033 to 0.140 ± 0.052 mm2, TISA750 enlarged from 0.125 ± 0.052 to 0.256 ± 0.089 mm2 at the third month (p < 0.01). CONCLUSION: Phacoemulsification surgery increases the ACD and enlarged the angle in the PACS eyes.
Collapse
Affiliation(s)
- Anh Tuan Vu
- Deparment of Ophthalmology, Hanoi Medical University, Hanoi, Vietnam
| | - Van Anh Bui
- Vietnam National Institute of Ophthalmology, Hanoi, Vietnam
| | - Hai Long Vu
- Deparment of Ophthalmology, Hanoi Medical University, Hanoi, Vietnam
| | - Do Quyet
- Vietnam Military Medical University (VMMU), Hanoi, Vietnam
| | - Than Van Thai
- NTT Hi-tech Institute, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Vu Thi Nga
- Institute for Research and Development, Duy Tan University, 03 Quang Trung, Danang, Vietnam
| | - Toi Chu Dinh
- Department of Human and Animal Physiology, Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam
| | - Nguyen Duy Bac
- Vietnam Military Medical University (VMMU), Hanoi, Vietnam
| |
Collapse
|
7
|
Razeghinejad MR, Myers JS. Contemporary approach to the diagnosis and management of primary angle-closure disease. Surv Ophthalmol 2018; 63:754-768. [PMID: 29777727 DOI: 10.1016/j.survophthal.2018.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/19/2018] [Accepted: 05/07/2018] [Indexed: 12/19/2022]
Abstract
The primary angle-closure disease spectrum varies from a narrow angle to advanced glaucoma. A variety of imaging technologies may assist the clinician in determining the pathophysiology and diagnosis of primary angle closure, but gonioscopy remains a mainstay of clinical evaluation. Laser iridotomy effectively eliminates the pupillary block component of angle closure; however, studies show that, in many patients, the iridocorneal angle remains narrow from underlying anatomic issues, and increasing lens size often leads to further narrowing over time. Recent studies have further characterized the role of the lens in angle-closure disease, and cataract or clear lens extraction is increasingly used earlier in its management. As a first surgical step in angle-closure glaucoma, lens extraction alone often effectively controls the pressure with less risk of complications than concurrent or stand-alone glaucoma surgery, but may not be sufficient in more advanced or severe disease. We provide a comprehensive review on the primary angle-closure disease nomenclature, imaging, and current laser and surgical management.
Collapse
Affiliation(s)
- M Reza Razeghinejad
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA; Poostchi Ophthalmology Research Center, Shiraz University of Medcial Sciences, Shiraz, Iran.
| | - Jonathan S Myers
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| |
Collapse
|
8
|
Kwon J, Sung KR. Factors Associated with Outcomes of Combined Phacoemulsification and Ahmed Glaucoma Valve Implantation. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 32:211-220. [PMID: 29770636 PMCID: PMC5990640 DOI: 10.3341/kjo.2017.0105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/12/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate outcomes and factors associated with surgical failure in patients who underwent combined phacoemulsification and Ahmed glaucoma valve (AGV) implantation. Methods This retrospective and longitudinal study enrolled 40 eyes (38 patients) that underwent combined phacoemulsification and AGV implantation. Visual acuity, intraocular pressure (IOP), and number of antiglaucoma medications were evaluated preoperatively and postoperatively. Complete success was defined as a last follow-up IOP of 6 to 21 mmHg without medication, qualified success as an IOP of 6 to 21 mmHg with medication, and failure as an IOP of >21 or <6 mmHg. Results The mean follow-up period was 18 ± 10 months. Preoperative diagnoses were chronic angle closure glaucoma (35.0%), neovascular glaucoma (22.5%), uveitic glaucoma (17.5%), primary open-angle glaucoma (15.0%), and other (10.0%). IOP decreased from a mean of 30.5 ± 8.7 to 14.5 ± 3.7 mmHg at the last follow-up visit (p < 0.001). Treatment was classified as qualified success in 18 eyes (45%), complete success in 15 (37.5%), and failure in seven (17.5%). Twenty-two eyes (55%) showed improvement in visual acuity. The most common postoperative complication was a transient hypertensive phase (five eyes, 12.5%). Tube-iris touch was associated with surgical failure (hazard ratio, 8.615; p = 0.008). Conclusions Combined phacoemulsification and AGV implantation is an effective and safe surgical option for patients with refractory glaucoma and cataract. Postoperative tube-iris touch is an indicator of poor prognosis.
Collapse
Affiliation(s)
- Junki Kwon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Rim Sung
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| |
Collapse
|
9
|
Phacoemulsification and goniosynechialysis for the management of refractory acute angle closure. Eur J Ophthalmol 2018; 22:714-8. [DOI: 10.5301/ejo.5000101] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2011] [Indexed: 11/20/2022]
|
10
|
Cetinkaya S, Dadaci Z, Yener HI, Acir NO, Cetinkaya YF, Saglam F. The effect of phacoemulsification surgery on intraocular pressure and anterior segment anatomy of the patients with cataract and ocular hypertension. Indian J Ophthalmol 2016; 63:743-5. [PMID: 26632135 PMCID: PMC4705715 DOI: 10.4103/0301-4738.171020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We evaluated the effect of phacoemulsification surgery on intraocular pressure (IOP), anterior chamber depth (ACD), iridocorneal angle (ICA), and central corneal thickness (CCT) of the patients with cataract and ocular hypertension. The decrease in IO P values of the 1 st week, 1 st month, 3 rd month, 6 th month, and 1 st year was statistically significant, but that of the 2 nd year was not significant. The increase in ACD and ICA values of the 1 st week, 1 st month, 3 rd month, 6 th month, and 1 st year was statistically significant, but that of the 2 nd year was not significant. The increase in CCT values of 1 st week and 1 st month was statistically significant, but those of 3 rd month, 6 th month, 1 st year, and 2 nd year were not significant. In conclusion, phacoemulsification surgery decreases IOP and increases ACD and ICA in the short-term. However, in the long-term it does not cause any significant changes.
Collapse
Affiliation(s)
- Servet Cetinkaya
- Department of Ophthalmology, Ophthalmology Clinics, Turkish Red Crescent Hospital, Konya, Turkey
| | | | | | | | | | | |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Wang F, Wu ZH. Phacoemulsification versus combined phacotrabeculectomy in the treatment of primary angle-closure glaucoma with cataract: a Meta-analysis. Int J Ophthalmol 2016; 9:597-603. [PMID: 27162736 DOI: 10.18240/ijo.2016.04.21] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 06/01/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the efficacy and safety of phacoemulsification (Phaco) against combined phacotrabeculectomy (Phacotrabe) in primary angle-closure glaucoma (PACG) with coexisting cataract. METHODS By searching electronically the PubMed, EMBASE, Scientific Citation Index and Cochrane Library published up from inception to January 2014, all randomized controlled trials that matched the predefined criteria were included. The quality of included trials was evaluated according to the guidelines developed by the cochrane collaboration. And the outcomes estimating efficacy and safety of two different surgical treatments were measured and synthesised by RevMan 5.0. RESULTS Five randomized controlled trials were selected and included in Meta-analysis with a total of 468 patients (468 eyes) with both PACG and cataract. We found that Phacotrabe had a greater intraocular pressure (IOP) lowing effect [preoperative IOP: weighted mean difference (WMD)=0.58, 95% confidence intervals (95% CI, -0.53 to 1.69), P=0.31; postoperative IOP: WMD=1.37, 95% CI (0.45 to 2.28), P=0.003], a lower number of anti-glaucoma medications [ risk ratio (RR) =0.05, 95% CI (0.02 to 0.18), P<0.00001] needed postoperatively and less serious damage of optic nerve [risk ratio (RR)=0.48, 95% CI (0.21 to 1.07), P=0.07], but a higher risk of complications [odds ratio (OR) =0.04, 95% CI (0.01 to 0.16), P<0.00001] compared with Phaco. The rest studies indicated that there had no significantly difference between the two surgical methods for postoperative best-corrected visual acuity (BCVA) [WMD=-0.05, 95% CI (-0.14 to 0.05), P=0.32] and loss of visual field [OR=1.06, 95% CI (0.61 to 1.83), P=0.83]. CONCLUSION Phaco alone compared with Phacotrabe had a better effect in IOP reduction, whereas the security decline. Considering the number of sample size, our results remains to be further studied.
Collapse
Affiliation(s)
- Fang Wang
- Department of Ophthalmology, the General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China
| | - Zhi-Hong Wu
- Department of Ophthalmology, the General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China
| |
Collapse
|
13
|
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]
|
14
|
Hou X, Hu D, Cui Z, Zhou J, Cai L, Wang Y. Small-incision phacotrabeculectomy versus phacoemulsification in refractory acute primary angle closure with cataract. BMC Ophthalmol 2015. [PMID: 26220093 PMCID: PMC4517567 DOI: 10.1186/s12886-015-0074-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Acute primary angle closure (PAC) can be refractory to conventional treatment and intraocular pressure (IOP) is beyond control. Surgical intervention should be considered at the moment. The aim of the study was to compare small-incision phacotrabeculectomy (phacotrab, small-incision trabeculectomy combined with phacoemulsification) with phacoemulsification (phaco) in patients with refractory acute PAC and coexisting cataract. Methods Analyzed 49 eyes (49 patients) with acute PAC and cataract received small-incision phacotrab (24 eyes) or phaco (25 eyes) randomly. All these cases were refractory to conventional treatment involved the use of preoperative topical IOP-lowering agents, corticosteroids, mannitol, methazolamide and paracentesis to reduce IOP. The effects on best corrected visual acuity (BCVA), IOP, anterior chamber depth (ACD), glaucoma medications, and complications were observed for twelve months. Results After operation BCVA of 18 patients (75 %) in phacotrab group and 20 patients (80 %) in phaco group improved compared to preoperative vision. No statistically significant differences in mean BCVA were found between the two groups. The mean postoperative IOP levels at all follow up time points were lower than the mean preoperative IOP in each group (P <0.001). There was statistically significant difference in mean IOP between the two groups only at 12 months postoperatively (P = 0.006). The surgical success rate (without medications, IOP ≤ 21 mmHg) was 83.33 % (20 eyes) and 72 % (18 eyes) in phacotrab group and phaco group respectively at 12 months. No statistically significant differences in the mean ACD were found between the two groups. There were no serious intra- or post-operative complications in the two treatment groups. Conclusions Besides phaco, small incision phacotrab may be another effective and safe choice in the treatment of patients with refractory acute PAC and coexisting cataract. Whether phacotrab is more effective in IOP control in the long term needs to be verified in the further.
Collapse
Affiliation(s)
- Xu Hou
- Eye Institute of Chinese PLA and Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China.
| | - Dan Hu
- Eye Institute of Chinese PLA and Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China.
| | - Zhili Cui
- Eye Institute of Chinese PLA and Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China.
| | - Jian Zhou
- Eye Institute of Chinese PLA and Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China.
| | - Li Cai
- Eye Institute of Chinese PLA and Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China.
| | - Yusheng Wang
- Eye Institute of Chinese PLA and Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China.
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Postoperative refractive error following cataract surgery after the first attack of acute primary angle closure. Int Ophthalmol 2013; 34:805-8. [PMID: 24234424 DOI: 10.1007/s10792-013-9878-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
Abstract
To investigate differences between preoperative target refraction and postoperative spherical equivalent refraction in eyes with the first attack of acute angle closure glaucoma before and after surgery. We retrospectively examined eyes of 36 patients who suffered the first attack of acute primary angle closure after undergoing cataract extraction and intraocular lens implant. We measured keratometric values (K1, K2) due to medical therapy for high ocular tension and the mean time interval until surgery. We compared the axial length, expected diopter, logMAR visual acuity, K1, K2, refractive spherical equivalent, and intraocular pressure (IOP) before and 6 months after surgery. The average preoperative IOP was 51.3 ± 9.0 mmHg, but it decreased to 14.8 ± 3.6 mmHg after surgery. No corneal edema was observed after surgery. The average axial length was 22.12 ± 1.03 mm and there was no significant change in keratometric values, which were 7.72 ± 0.33 mm (K1) and 7.51 ± 0.31 mm (K2) before surgery and 7.67 ± 0.33 mm (K1) and 7.49 ± 0.29 mm (K2) after surgery. Similarly, no significant difference was observed in average preoperative target refractive error (-0.57 ± 0.53 D) and average postoperative refractive spherical equivalent (-0.67 ± 0.97 D). The inability to accurately determine preoperative refractive error due to corneal edema or other complications is a concern during the first attack of acute angle closure glaucoma. However, our results indicate that no differences should be expected between preoperative refractive error and postoperative refractive spherical equivalent.
Collapse
|
17
|
Park JW, Jung HH, Park SW. The Effect of Capsular Tension Ring in Patients with a History of Acute Primary Angle Closure. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.9.1395] [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)
- Jung Won Park
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun Ho Jung
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Woo Park
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| |
Collapse
|
18
|
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
| |
Collapse
|
19
|
Boulanger G, Orignac I, Weber M. [Demographic evolution of acute primary angle closure between 2001-2003 and 2008-2010: impact of modern cataract surgery]. J Fr Ophtalmol 2012; 36:95-102. [PMID: 22981524 DOI: 10.1016/j.jfo.2012.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 12/20/2011] [Accepted: 01/14/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE To study the demographic evolution of acute primary angle closure. MATERIALS AND METHODS Retrospective study of patients with acute primary angle closure treated between 2001-2003 and 2008-2010. For each period, a comparison was made of demographic data (number of cases, age at diagnosis, sex), clinical data (biometry, presence or absence of iris plateau or cataract) and therapeutic data (iridotomy, phacoemulsification, trabeculectomy). RESULTS Fifty-two cases of acute primary angle closure were treated in the University Hospital of Nantes, France: 34 eyes in 2001-2003 and 18 in 2008-2010, representing a decrease of 47% in acute primary angle closure cases in 7years. The incidence of acute primary angle closure attacks significantly decreased from 0.0596% in 2001-2003 to 0.0224% in 2008-2010. Acute angle closure attacks secondary to cataract decreased significantly from 82% in 2001-2003 to 50% in 2008-2010. In cataractous cases with ocular hypertension persisting after peripheral iridotomy, cataract extraction was performed. Early phacoemulsification less than 10days was significantly more common in 2008-2010 than in 2001-2003 (40% versus 10%). CONCLUSION This study confirms the recent decrease in acute primary angle closure attacks. The consistent increase in cataract surgery in the elderly has probably played a preventive role, since the highest decrease in acute primary angle closure cases was observed among the 70-80-year-old population. Recently, acute primary angle closure cases are less often due to cataract than to primary pupillary block or iris plateau. The prevention of acute primary angle closure by gonioscopic monitoring in patients at risk is indispensable.
Collapse
Affiliation(s)
- G Boulanger
- Service d'ophtalmologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | | | | |
Collapse
|
20
|
Tang Y, Qian S, Wang J, Yao J, Xu J, Cheng L, Zhou C. Effects of combined phacoemulsification and viscogoniosynechialysis versus trabeculectomy in patients with primary angle-closure glaucoma and coexisting cataract. ACTA ACUST UNITED AC 2012; 228:167-73. [PMID: 22739037 DOI: 10.1159/000338241] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 03/18/2012] [Indexed: 11/19/2022]
Abstract
AIMS To compare the effectiveness of combined phacoemulsification and viscogoniosynechialysis versus trabeculectomy alone in primary angle-closure glaucoma (PACG) with a coexisting cataract. METHODS Thirty-nine Chinese patients (39 eyes) were retrospectively analyzed: 19 patients underwent combined phacoemulsification and viscogoniosynechialysis (group 1), and 20 underwent trabeculectomy (group 2). In both groups, the intraocular pressure (IOP), the number of antiglaucoma medications, the best corrected visual acuity (BCVA), the central anterior chamber depth (ACD), the synechial/apposition angle closure (SAC), and the success rates were assessed. RESULTS The median follow-up periods were similar for both groups (10 months). At the last follow-up, the mean IOP was 14.09 ± 6.89 mm Hg and the mean number of antiglaucoma medications was 0.36 ± 0.59 in group 1; in group 2, the mean IOP was 16.48 ± 4.74 mm Hg (p = 0.066) and the mean number of antiglaucoma medications was 1.05 ± 0.99 (p = 0.025). In terms of the mean central ACD and the mean SAC, there were significant differences between the groups (p = 0.0000, respectively). Kaplan-Meier analysis revealed that the cumulative probability of success in group 1 was higher than that in group 2 (p = 0.0051). CONCLUSION Compared to trabeculectomy, combined phacoemulsification and viscogoniosynechialysis resulted in a lower requirement for glaucomatous medications, a greater improvement in BCVA, and a higher cumulative probability that treatment would be successful among patients with PACG and coexisting cataracts.
Collapse
Affiliation(s)
- Yating Tang
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, PR China
| | | | | | | | | | | | | |
Collapse
|
21
|
Huang G, Gonzalez E, Lee R, Chen YC, He M, Lin SC. Association of biometric factors with anterior chamber angle widening and intraocular pressure reduction after uneventful phacoemulsification for cataract. J Cataract Refract Surg 2011; 38:108-16. [PMID: 22055073 DOI: 10.1016/j.jcrs.2011.06.037] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 06/24/2011] [Accepted: 06/27/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To evaluate anterior chamber biometric factors associated with the degree of angle widening and intraocular pressure (IOP) reduction after phacoemulsification. SETTING University of California, San Francisco, California, USA. DESIGN Case series. METHODS Anterior chamber parameters obtained by anterior segment coherence tomography were compared preoperatively and 3 months postoperatively. Measurements included the angle opening distance 500 μm anterior to the scleral spur (AOD500), trabecular-iris space area 500 μm from the scleral spur (TISA500), iris curvature (I-Curv), anterior chamber angle (ACA), trabecular-iris space area, anterior chamber volume, anterior chamber width, and lens vault (LV). RESULTS The study enrolled 73 eyes. The mean patient age was 77.45 years ± 7.84 (SD); 65.75% of patients were women. From preoperatively to 3 months postoperatively, the mean AOD500 increased significantly (0.254 ± 0.105 to 0.433 ± 0.108 mm) and the mean IOP decreased significantly (14.97 ± 3.35 to 12.62 ± 3.37 mm Hg) (P<.001). The reduction in IOP was correlated with the increase in AOD500 (r = 0.240, P=.041) and preoperative LV (r = 0.235, P=.045). After adjusting for related factors, AOD500 widening was positively correlated with LV (β = 0.458, P=.044) and I-Curv (β = 0.235, P=.043) and negatively correlated with preoperative TISA500 (β = -0.269, P=.025) and ACA (β = -0.919, P=.027). CONCLUSIONS Surgically induced AOD widening was significantly correlated with anterior chamber biometric factors. Preoperative LV appears to be a significant factor in angle widening and IOP reduction after phacoemulsification.
Collapse
Affiliation(s)
- Guofu Huang
- Department of Ophthalmology, University of California, San Francisco, California 94133-0730, USA
| | | | | | | | | | | |
Collapse
|
22
|
Ultrasound biomicroscopic assessment of angle parameters in patients with primary angle closure glaucoma undergoing phacoemulsification. Eur J Ophthalmol 2011; 21:559-65. [PMID: 21279978 DOI: 10.5301/ejo.2011.6287] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the effect of phacoemulsification and foldable intraocular lens (IOL) implantation on biometric determinants of the anterior chamber angle in primary angle closure glaucoma (PACG) using ultrasound biomicroscopy (UBM). METHODS Forty-six eyes of 46 patients with chronic PACG and cataract having a patent laser iridotomy were included in this prospective, interventional case series. Angle parameters were measured using UBM before surgery and 3 months after phacoemulsification with IOL implantation. Intraocular pressure (IOP) was measured by applanation tonometer and records of glaucoma medication administered were maintained. Main outcome measures were IOP, central anterior chamber depth (ACD), trabecular iris angle (TIA), and angle opening distance at 250 and 500 µm from scleral spur (AOD250 and AOD500). RESULTS The mean age of study participants was 56.5 ± 9.9 years (range 44-75). The preoperative mean IOP was 25.0 ± 5.4 mmHg on maximum antiglaucoma medication, which was reduced to 15.8 ± 3.8 mmHg (p = 0.0001) at 3 months. Number of antiglaucoma medications also decreased from 2.4 ± 1.1 to 0.4 ± 1.1 (p = 0.0001). There was a significant widening of the anterior chamber angle with the TIA increasing significantly after phacoemulsification (p<0.001) with an associated increase in AOD250, AOD500, and ACD (p<0.001). CONCLUSIONS Phacoemulsification in eyes with PACG results in significant widening of the anterior chamber angle. This results in better IOP control after surgery and decreases the need for glaucoma medications. These findings are of clinical significance in obviating the need for simultaneous filtering surgery in eyes with PACG undergoing phacoemulsification cataract surgery.
Collapse
|
23
|
Su WW, Chen PYF, Hsiao CH, Chen HSL. Primary phacoemulsification and intraocular lens implantation for acute primary angle-closure. PLoS One 2011; 6:e20056. [PMID: 21629644 PMCID: PMC3101225 DOI: 10.1371/journal.pone.0020056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 04/24/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To investigate the effect of primary phacoemulsification on intraocular pressure (IOP) in patients with acute primary angle-closure (PAC) and coexisting cataract. METHODOLOGY Sixteen eyes of 14 patients with acute PAC received phacoemulsification and intraocular lens implantation as initial management for medically uncontrolled IOP in a retrospective chart review. The effects on IOP, vision, anterior chamber depth (ACD), and number of antiglaucoma medications were evaluated. PRINCIPAL FINDINGS The postoperative IOP was reduced in 16 eyes (100%). The mean ± standard deviation preoperative IOP was 48.81 ± 16.83 mm Hg, which decreased postoperatively to 16.46 ± 10.67 mm Hg at 1 day, 9.43 ± 3.03 mm Hg at 1 week, 9.49 ± 2.14 mm Hg at 2 weeks, 10.78 ± 3.56 mm Hg at 1 month, and 10.70 ± 2.80 mm Hg at 3 months (p < 0.001). The mean number of antiglaucoma medications decreased from 3.56 ± 1.14 to 0.13 ± 0.34 (p < 0.001). The average preoperative ACD was 2.08 ± 0.35 mm, which increased to 3.59 ± 0.33 mm after surgery (p < 0.001). Visual acuity (converted into logarithm of the minimum angle of resolution [logMAR]) improved from 1.14 ± 0.71 to 0.73 ± 0.53 (p = 0.001). CONCLUSIONS Primary phacoemulsification plus intraocular lens implantation lowered IOP, reduced the use of antiglaucoma medications, and improved vision in patients with acute PAC. This is a safe and effective method of IOP control and can be considered a first treatment option in managing patients with acute PAC and coexisting cataract.
Collapse
Affiliation(s)
- Wei-Wen Su
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Phil Yeong-Fung Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Henry Shen-Lih Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- * E-mail:
| |
Collapse
|
24
|
Current World Literature. Curr Opin Ophthalmol 2011; 22:141-6. [DOI: 10.1097/icu.0b013e32834483fc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|