The effect of phacoemulsification plus goniosynechialysis in acute and chronic angle closure patients with extensive goniosynechiae

How much does cataract surgery contribute to intraocular pressure lowering?

PURPOSE OF REVIEW

To review the literature evaluating the effect of cataract surgery on intraocular pressure (IOP) in patients with glaucoma.

RECENT FINDINGS

Recent high-quality secondary analyses of large and primary trials continue to show IOP lowering following cataract surgery. Likewise, cataract surgery remains a key treatment for angle closure glaucoma. Some micro-invasive glaucoma surgeries (MIGS) have strong evidence to be performed at the time of cataract surgery. Data clarifying when these surgeries should be combined with cataract surgery is emerging. The mechanism underlying IOP lowering after cataract surgery remains unclear.

SUMMARY

Patients who are glaucoma suspects with visually significant cataracts would benefit from cataract surgery alone. Those with mild-moderate damage on 1-2 classes of medications would most likely benefit from additional MIGS. Patients with advanced disease would benefit from cataract surgery and a choice of additional surgery, which depends on disease status and patient factors. Clear lens extraction is becoming a more accepted practice as a primary procedure for patients with angle closure and high IOP or glaucoma. The role of additional MIGS in angle closure needs further study.

Comparison of Long-Term Effects Following Phacoemulsification Combined with Goniosynechialysis and Trabeculectomy in Patients with Primary Angle-Closure Glaucoma and Cataract

INTRODUCTION

Goniosynechialysis (Phaco-GSL) is a logical therapeutic approach for patients with primary angle-closure glaucoma (PACG) and cataract. The aim of this study was to compare the long-term effectiveness and safety of Phaco-GSL and trabeculectomy (TRB) in the management of PACG with coexisting cataract.

METHODS

A review was conducted on 96 Chinese patients (96 eyes) with PACG and cataract from Peking Union Medical College Hospital (PUMCH). Among them, 56 patients underwent Phaco-GSL, while 40 underwent TRB. Intraocular pressure (IOP), best corrected visual acuity (BCVA), use of supplemental antiglaucoma medical therapy, surgery success rates, and complications for both procedures were assessed.

RESULTS

The average follow-up period was 50.3 ± 18.7 months in the Phaco-GSL group and 61.2 ± 15.1 months in the TRB group. At the final follow-up, IOP decreased from 27.0 ± 11.1 mmHg to 13.5 ± 2.1 mmHg in the Phaco-GSL group and in the TRB group IOP decreased from 27.1 ± 7.7 mmHg to 16.5 ± 5.5 mmHg. The long-term postoperative IOP in the Phaco-GSL group was significantly lower than that in the TRB group. There was a statistically significant reduction in medication usage in both groups, with the TRB group having a higher number of postoperative medications at the final follow-up. The incidence of postoperative complications was significantly higher in the TRB group compared to the Phaco-GSL group.

CONCLUSIONS

Phaco-GSL is the recommended surgical approach for Chinese patients with primary angle-closure glaucoma (PACG) and cataract. Compared to traditional TRB, eyes undergoing Phaco-GSL show a reduced requirement for antiglaucomatous medications, improved management of IOP, decreased risk of complications, and higher long-term cumulative probability of treatment success for patients with PACG.

Glauco-Claw: A novice implant for chronic angle-closure glaucoma

This article describes 1-year outcomes of a new intra-ocular implant, "Glauco-Claw," in refractory chronic angle-closure glaucoma (ACG). Glauco-Claw is a novice polymethylmethacrylate implant with a central ring and five claws placed circumferentially. It was placed in the anterior chamber and the peripheral iris was tucked into the claws, thus causing goniosynechialysis and preventing the reformation of goniosynechiae. It was implanted in five eyes of five patients, and they were followed up for 1 year. Target intra-ocular pressure was achieved and maintained in all the patients till the last follow-up. Two patients did not require any anti-glaucoma medication. No significant complications were observed in any patient. Glauco-Claw could be another armamentarium in the management of refractory chronic ACG.

Phaco-goniosynechialysis versus phaco-trabeculectomy in patients with refractory primary angle-closure glaucoma: a comparative study

PURPOSE

To compare the effects of phacoemulsification with intraocular lens implantation (phaco) combined with goniosynechialysis (phaco + GSL) versus phaco with trabeculectomy (phaco + trab) for the management of primary angle-closure glaucoma (PACG) refractory to peripheral anterior synechiae (PAS) of over 180°.

METHODS

This retrospective study followed 77 eyes of 77 patients for at least 6 months. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of glaucoma drugs, and PAS were recorded at the preoperative baseline and evaluated at each postoperative follow-up visit. The National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) was administered to patients enrolled in this study. Pearson's correlation analysis and multivariate linear analysis were performed to identify factors influencing changes in NEI VFQ-25 scores and to identify factors associated with increases in NEI VFQ-25 scores after the operation.

RESULTS

In total, seventy-seven eyes were included (43 with phaco + GSL and 34 with phaco + trab). Comparing preoperative baseline and month 6 after surgery measurements revealed that both groups found significant improvements in IOP, PAS, BCVA and the number of glaucoma drugs (P < 0.05). Baseline NEI VFQ-25 scores were similar in the two groups, but there was a significant difference in postoperative NEI VFQ-25 scores (74.47 ± 10.39 in phaco + GSL vs. 69.57 ± 8.54 in phaco + trab, P = 0.048 < 0.05), and the phaco + GSL group had better scores at the time of the last follow-up. The change in preoperative scores and the number of glaucoma drugs was significantly correlated with postoperative scores in the phaco + GSL group.

CONCLUSION

Phaco + GSL treatment is as safe and effective as phaco + trab for refractory PACG patients, and patients' subjective experience improved significantly after phaco + GSL surgery.

Preparation of an amphiphilic peptide (P13) with proton sponge effect and analysis of its antitumor activity

In order to prevent drugs from being captured and degraded by the acidic environment of organelles, such as lysosomes, after entering cells, this study designed and synthesized a novel carrier amphiphilic polypeptide (DGRHHHLLLAAAA), designated P13, for use as a tumor-targeting drug delivery vehicle. The P13 peptide was synthesized by the solid phase synthesis method, and its self-assembly behavior and drug-loading capacity in aqueous solution were studied and characterizedin vitro. Doxorubicin (DOX) was loaded by dialysis method, and P13 and DOX were mixed at a mass ratio of 6:1 to form regular rounded globules. The acid-base buffering capacity of P13 was investigated determined by acid-base titration. The results revealed that P13 had excellent acid-base buffering capacity, a critical micelle concentration value of about 0.000 21 g l^-1, and the particle size of P13-Dox nanospheres was 167 nm. The drug encapsulation efficiency and drug loading capacity of micelles were 20.40 ± 1.21% and 21.25 ± 2.79%, respectively. At the concentration of 50μg ml^-1of P13-DOX , the inhibition rate was 73.35%. The results of thein vivoantitumor activity assay in mice showed that P13-DOX also exhibited excellent inhibitory effect on tumor growth, compared with the tumor weight of 1.1 g in the control group, the tumor weight in the P13-DOX-treated group was only 0.26 g. Additionally, the results of hematoxylin and eosin staining of the organs showed that P13-DOX had no damaging effect on normal tissues. The novel amphiphilic peptide P13 with proton sponge effect designed and prepared in this study is expected to be a promising tumor-targeting drug carrier with excellent application potential.

Changes in Anterior Chamber Angle and Choroidal Thickness in Patients with Primary Angle-Closure Glaucoma after Phaco-Goniosynechialysis

We aimed to observe changes in angle width and choroidal thickness (CT) before and after phacoemulsification intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) in patients with primary angle-closure glaucoma (PACG) complicated by cataracts. This prospective cohort study included 60 patients with PACG complicated by cataracts from the Department of Ophthalmology of Shaoxing People’s Hospital, China. Patients underwent PEI combined with GSL (PEI-GSL group) or laser peripheral iridotomy (LPI) followed by PEI (PEI group). Intraocular pressure (IOP) and endothelial counts were significantly decreased in both groups after surgery, while best-corrected visual acuity and central anterior chamber depth were significantly increased. However, there were no significant differences between the two groups. The opening degrees of room corners at 12, 3, 6, and 9 o’clock were recorded as AA12, AA3, AA6, and AA9, respectively. Anterior chamber depth was significantly increased postoperatively compared to preoperatively in both groups, with no significant between-group differences (all ps > 0.05). At 1, 3, and 6 months postoperatively, the width at AA12, AA3, and AA9 points was higher in the PEI-GSL group than in the PEI group (all ps < 0.05). Significant between-group differences at AA6 were observed preoperatively (p = 0.023) and at 1 (p = 0.027) and 3 (p = 0.033) months postoperatively but not at 6 months postoperatively (p = 0.055). CT was smaller postoperatively than preoperatively (all ps < 0.001). The present study suggests that patients with PACG who underwent PEI with or without GSL had reduced IOP and CT after surgery.

Minimally Invasive Glaucoma Surgery in Primary Angle-Closure Glaucoma

Primary angle-closure glaucoma (PACG) is responsible for half of the glaucoma-related blindness worldwide. Cataract surgery with or without trabeculectomy has been considered to be the first-line treatment in eyes with medically uncontrolled PACG. While minimally invasive glaucoma surgery has become an important surgical approach for primary open-angle glaucoma, its indications and benefits in PACG are less clear. This review summarizes the efficacy and safety profile of minimally invasive glaucoma surgery in PACG to unfold new insights into the surgical management of PACG.

The Role of Automated Peripheral Iridectomy Combined with Phacoemulsification and Mini Ex-PRESS Shunt Implantation in Patients with Chronic Angle Closure Glaucoma

Purpose

To evaluate the role of automated peripheral iridectomy as an adjunctive tool combined with phacoemulsification and ExPRESS shunt implantation in management of cases with chronic angle closure glaucoma.

Setting

Magrabi eye hospital.

Methods

This prospective study included 22 eyes of 22 patients with chronic angle closure glaucoma and cataract who underwent Ex-PRESS shunt implantation, cataract extraction and surgical peripheral iridectomy at the site of shunt implantation in the period between January 2018 and April 2020.

Results

After surgery, the mean IOP was 11.3±1.2 mm Hg, 14.5±1.6 mm Hg, 14.8±2.1 mm Hg, 15.3±1.9 mm Hg and 17.4±1.8 mm Hg at 7 days, 1 month, 3 months, 6 months and 12 months, respectively. All postoperative IOP was significantly lower compared with preoperative IOP (P = 0.001). There was a significant decrease in the number of medications required after surgery. The baseline mean number of medications was 3.4±0.02 (range from 1 to 4), while postoperatively the mean number of medications decreased to 0.7±0.01 at 12 months (P < 0.01). The qualified success rate was 6/22 eyes, and the complete success rate was 16/22 (72.7%) at 12 months, respectively.

Conclusion

The combined phacoemulsification and Ex-PRESS shunt implantation with automated peripheral iridectomy is an effective and safe procedure to treat chronic angle closure glaucoma.

Efficacy of Combined Phacoemulsification and Goniosynechialysis in Primary Angle Closure Disease With Different Degrees of Peripheral Anterior Synechiae

PRCIS

Phacoemulsification and goniosynechialysis (Phaco-GSL) was equally effective in the treatment of primary angle-closure disease (PACD) with preoperative peripheral anterior synechiae (PAS) <180 degrees and larger than 180 degrees. Patients with a larger preoperative PAS range required more range of mechanical separation intraoperatively and displayed more recurrence of PAS (re-PAS) range postoperatively.

PURPOSE

To evaluate the long-term efficacy of combined phaco-GSL in PACD with different extent of PAS.

PATIENTS AND METHODS

A retrospective study was conducted on 67 patients (79 eyes) who received phaco-GSL. The patients were divided into 2 groups according to the extent of PAS (group A: PAS ≤180 degrees; group B: PAS >180 degrees). Changes in intraocular pressure (IOP), the number of anti-glaucoma drugs, intraoperative mechanical separation of PAS and range of re-PAS during the last follow-up ≥12 months were analyzed.

RESULTS

At baseline, eyes in group B presented with higher IOP and more anti-glaucoma drugs usage ( P =0.008 and 0.004). The PAS range, IOP, number of anti-glaucoma medication were reduced both in 2 groups at the final visit. The range of mechanical separation intraoperatively and re-PAS postoperatively were both larger in group B ( P =0.002 and <0.001). The postoperative re-PAS range was positively correlated with the range of mechanical separation ( R2 =0.17). The complete success rates at 12, 24, 36, and 48 months were 86.8%, 71.1%, 71.1%, and 71.1% in group A; and 80.5%, 74.6%, 69.9%, and 69.9% in group B. The qualified success rates were 100%, 96.6%, 92.0%, and 92.0% in group A; and 100%, 89.5%, 85.1%, and 85.1% in group B.

CONCLUSION

Phaco-GSL for the treatment of PACD showed equally effective IOP control regardless of the extent of preoperative PAS.

EFFICACY OF PHACOEMULSIFICATION AND PHACOEMULSIFICATION COMBINED WITH GONIOSYNECHIALYSIS IN SURGICAL TREATMENT OF CHRONIC ANGLE-CLOSURE GLAUCOMA: 2-YEARS STUDY

Aim. To study the degree of angle opening and the decrease of intraocular pressure in primary angle-closure glaucoma (PACG) after cataract phacoemulsification and cataract phacoemulsification with goniosynechialysis (phaco + GLS). Materials and Methods. The study involved 28 patients (28 eyes) with primary chronic angle-closure glaucoma. The patients were divided into two groups, group 1 of 15 patients undergoing phaco with posterior chamber IOL implantation, and group 2 of 13 patients undergoing phaco with IOL implantation and GLS. The patients were followed for 24 months. Phaco was indicated in cases with IOP above 22 mmHg, appositional anterior chamber angle closure, and optic neuropathy; Phaco with GSL was indicated in cases of synechial angle closure and IOP above 22 mmHg Results. In group 1 after Phaco, postoperative anterior chamber angle opening was >20° in all quadrants. Postoperative IOP after 24 month follow-up it decreased by 32,6 % from the preoperative levels. In group 2 after Phaco+GSL, anterior chamber angle opened at least to 20° in three or more quadrants in all cases. Postoperative IOP after 24 month follow-up it decreased by 33.0% from the preoperative levels. Conclusions. Thus, phacoemulsification is an efficient procedure for PACG and appositional angle closure, leading to reopening of the anterior chamber angle with significant IOP reduction. Phacoemulsification alone does not lead to reopening of anterior chamber angle in cases with synechial angle closure, necessitating a combined surgery of phacoemulsification with GSL.

[Phacoemulsification in prevention of acute angle-closure glaucoma attack]

Analysis of the effectiveness of preventative phacoemulsification (PE) in anatomically short eyes with an increased risk of an acute glaucoma attack in thickened lens can help in choosing the optimal management tactics for these patients.

PURPOSE

To study the changes in morphometric parameters of the anterior segment of anatomically short eyes with an increased risk of acute glaucoma attack before and after preventative PE.

MATERIAL AND METHODS

The study included 70 patients (70 eyes) with a high risk of acute glaucoma attack in short anatomical axial length and thickened lens, with posterior and middle positions of the ciliary body. They were divided into 2 groups: the main group consisted of 45 patients who agreed to undergo PE; the comparison group consisted of 25 patients who refused to undergo PE due to good visual functions and no complaints about vision. B-mode ultrasound examination of the anterior segment of the eye was used to evaluate the cross-sectional surface area of the lens (CSAL) and the cross-sectional surface area of the anterior chamber (CSAAC).

RESULTS

In the main group, on day 2-3 after PE the anterior chamber depth increased in all eyes, the CSAAC index increased, the anterior chamber angle (ACA) widened to Schaffer grade to II-III. After 1-3 years and 4-5 years, the anterior chamber depth, the CSAAC index and the width of the ACA remained stable. In the comparison group, after 1-3 years the anterior chamber depth and the CSAAC index significantly decreased, the ACA narrowed, and the intraocular pressure increased; after 4-5 years, there was a progressive increase in the CSAL index, the ACA was completely closed (0°).

CONCLUSION

In all cases of timely performed preventative PE, already on days 2-3 after surgery there was a statistically significant improvement in the main morphometric parameters of the eye, which remained stable for 4-5 years.

Efficacy and safety of phacoemulsification plus goniosynechialysis and trabectome in patients with primary angle-closure glaucoma

We evaluated the efficacy and safety of combined phacoemulsification, intraocular lens implantation, goniosynechialysis (GSL), and trabectome in patients with primary angle-closure glaucoma (PACG). Twenty patients (22 eyes) of PACG treated with combined phacoemulsification, intraocular lens implantation, GSL, and trabectome between September 2017 and September 2020 were included in this case series study. The intraocular pressure (IOP), number of glaucoma medications, and best-corrected visual acuity (BCVA) were recorded at baseline, 1, 3, 6, and 12 months after surgery. Successful surgery was defined as IOP < 21 mmHg with or without IOP-lowering medications. IOP was decreased significantly from 22.07 ± 6.62 mmHg at baseline to 15.06 ± 3.39 mmHg at 12 months' follow-up (p = 0.001). The number of glaucoma medications was significantly reduced from 2.68 ± 1.17 preoperatively to 0.78 ± 0.73 at 12 months' follow-up (p < 0.01). The rate of successful surgery was 88.9% at 12 months. The reduction in IOP showed a positive correlation with baseline IOP (p < 0.001), and the reduction in number of glaucoma medications was positively correlated with baseline number of glaucoma medications (p < 0.001). There were no vision-threatening complications intraoperatively or postoperatively. Combined phacoemulsification, IOL implantation, GSL, and trabectome were effective and safe in PACG patients in this study. These combined surgical techniques may be useful in PACG patients, especially those with long term and extensive peripheral anterior synechiae.

Real-world Surgical Outcomes of Primary Angle-closure Glaucoma

Purpose

To evaluate surgical outcomes of the four common procedures utilized for primary angle-closure glaucoma (PACG).

Methods

A retrospective study of survival rate in surgical management of PACG was conducted in a referral eye center. One hundred and ninety-nine eyes from 173 PACG patients were collected for chart review. The procedures used were phacoemulsification (PE), combined PE with goniosynechialysis (PE-GSL), combined PE with trabeculectomy (PE-Trab), and trabeculectomy alone. Failure was defined as postoperative IOP >21 mmHg in patients who needed second surgical intervention or those who had IOP <5 mmHg with loss of light perception. Cumulative survival rates, risk of surgical failure, and complications were analyzed.

Results

PE, PE-GSL, PE-Trab, and trabeculectomy were performed in 84 eyes (42.2%), 76 eyes (38.2%), 21 eyes (10.6%), and 18 eyes (9%), respectively. Cumulative survival rates at 60 months were 13%, 55%, 42% and 43%, respectively. Cox regression analysis indicated that each mmHg IOP increased, the risk of surgical failure decreased by 13% (adjusted hazard ratio (HR) 0.87; 95%CI: 0.84-0.93, p<0.001).

Conclusion

Real-world surgical outcomes of PACG showed that PE alone had a low survival rate of 13% in 60-month follow-up whereas PE-GSL achieved the highest rate of 55%. PE-GSL should be initially considered for management of PACG, since it can restore and sustain the physiologic aqueous pathway and preserve the conjunctiva for future filtering surgery if needed.

Comparing the Safety and Efficacy of Phacogoniosynechialysis With Phacotrabeculectomy in the Management of Refractory Acute Primary Closure Angle Glaucoma With Cataract: A Multicenter Randomized Trial

PRCIS

Combined phacoemulsification-goniosynechialysis (phaco-GSL) and unaugmented phacotrabeculectomy were both found to be effective in treating eyes with significant cataract and medically unresponsive acute primary angle closure glaucoma (PACG). Phaco-GSL seemed to be safer, with fewer surgical complications, and achieved better visual acuity than phacotrabeculectomy.

OBJECTIVES

To compare the results of combined phaco-GSL with unaugmented phacotrabeculectomy in the management of eyes with medically unresponsive acute PACG and cataract.

PARTICIPANTS AND RESEARCH METHODS

This was a prospective randomized controlled trial involving patients with significant cataract and acute PACG who were not responsive to maximal medical therapy. Three ophthalmic centers in Hanoi, Vietnam, participated in this trial. Study subjects were randomized into 2 groups: phaco-GSL or phacotrabeculectomy. Of note, mitomycin-C or 5-fluorouracil were not used during trabeculectomy, but postoperative bleb needling with 5-fluorouracil injection(s) was allowed. The primary outcome of the study was the rate of postoperative surgical complications in the first 3 months after surgery. The secondary outcome, determined at 1 year, assessed whether treatment was completely successful [defined as intraocular pressure (IOP)<21 mm Hg without IOP-lowering drops], or partially successful (IOP<21 mm Hg with IOP-lowering drops). Treatment failure was defined as IOP≥21 mm Hg with maximal IOP-lowering drops.

RESULTS

In total, 79 eyes from 79 patients (62 females, 17 males) were recruited (42 and 37 eyes in the phaco-GSL and phacotrabeculectomy groups, respectively). There were no statistically significant differences between the 2 groups at baseline in terms of age, visual acuity, IOP, anterior angle width, or preoperative ultrasound biomicroscopy index. Postoperative complications in the first 3 months were seen more frequently in the phacotrabeculectomy group (62.2%) than in the phaco-GSL group (14.3%, P<0.01). At 1 year postsurgery, treatment was 100% successful in both groups, with no difference in the mean IOP (15.38±3.42 vs. 15.72±4.47 mm Hg). The visual field index improved significantly following surgery in both groups, but there was also no significant difference between the 2 groups. However, there was a significant difference in the best corrected visual acuity at 1 year, with patients in the phaco-GSL group achieving better vision (0.45±0.21 logMAR in the phaco-GSL group vs. 0.64±0.27 logMAR in the phacotrabeculectomy group, P=0.04). The mean angle width was also significantly larger in the phaco-GSL group than the phacotrabeculectomy group (2.34±0.33 vs. 1.25±0.41 Shaffer degrees). Similarly, on ultrasound biomicroscopy, the anterior chamber was deeper after 12 months (2.87±0.28 to 2.48±0.33 mm), and the mean trabecular-iris angle area was wider at 12 months (21.88±7.07 vs. 14.95±4.39 degrees) in the phaco-GSL than the phacotrabeculectomy group.

CONCLUSIONS

Phaco-GSL and phacotrabeculectomy were both effective in treating medically unresponsive cases of acute PACG with cataracts. However, phaco-GSL showed better visual outcomes, wider drainage angles postsurgery, and fewer complications than phacotrabeculectomy.

Phacoemulsification with Goniosynechialysis versus Phacoemulsification Alone in Angle-Closure Glaucoma: A Meta-Analysis of Randomized Controlled Trials

Purpose

This meta-analysis aimed to compare the efficacy and safety of phacoemulsification with goniosynechialysis (Phaco-GSL) with those of phacoemulsification alone (Phaco-alone) in patients with angle-closure glaucoma and cataract.

Methods

Randomized controlled trials (RCTs) were selected through a search of electronic databases. Trial eligibility and risk of bias were assessed using Cochrane review methods. Primary measures included the intraocular pressure (IOP), number of antiglaucoma medications, peripheral anterior adhesion (PAS) extent, and their pre- and postoperative changes. For continuous parameters, we calculated weighted mean differences and 95% confidence intervals. Statistical analysis was performed using RevMan 5.3 software.

Results

Eight RCTs were included, where 224 and 236 eyes were in the Phaco-GSL and Phaco-alone groups, respectively. Both postoperative IOP and number of medications were not significantly different between the study groups at the six- and twelve-month follow-up. However, the 12-month postoperative PAS extent was significantly smaller in the Phaco-GSL group than in the Phaco-alone group. Similarly, changes from the preoperative to 12-month postoperative PAS extent were significantly greater in the Phaco-GSL group than in the Phaco-alone group, but IOP and the number of medication changes were not different.

Conclusions

Our results provide evidence that Phaco-GSL provides advantages over Phaco-alone treatment regarding PAS reduction. In terms of IOP and medication reduction, both groups were comparable. Thus, Phaco-GSL can be considered for the treatment of patients with angle-closure glaucoma and cataract due to its ease, safety, and potential benefit for the anterior chamber angle.

Morphological features of anterior segment: factors influencing intraocular pressure after cataract surgery in nanophthalmos

Purpose

To investigate the anterior segment in nanophthalmic eyes and their association with intraocular pressure after cataract surgery.

Methods

Thirty-two nanophthalmic eyes (axial length [AL] < 18.5 mm) in 18 patients and 35 normal eyes (21 ≤ AL ≤ 24.5 mm) in 35 controls who had undergone uneventful cataract surgery were included. Swept-source optical coherence tomography was used to compare the anterior segment structures between the two groups. The associations between the anterior segment characteristics of nanophthalmic eyes and postoperative intraocular pressure (IOP) were also investigated.

Results

The IOP-lowering effect of cataract surgery was remarkably insufficient in nanophthalmic eyes. Peripheral anterior synechiae (PAS) were observed in 56% (18/32) of nanophthalmic eyes, and a characteristic boomerang-shaped iris was observed in 28% (9/32). The anterior surface of the iris seemed “smoother” in nanophthalmic eyes than in normal eyes. Schlemm’s canal (SC) diameter, SC area, trabecular meshwork (TM) thickness, TM width, and TM area were generally smaller in the nanophthalmic eyes. Younger age, higher preoperative IOP, broader PAS, and smaller SC area were main contributors to higher postoperative IOP. AL and SC diameter may also be of great importance in IOP prediction in patients without glaucoma surgery and PAS.

Conclusions

The morphological features of the anterior segment in nanophthalmic eyes are significantly different from those of normal eyes. Influencing factors such as age, AL, preoperative IOP, extent of PAS, SC and TM size could all be prognostic for IOP after cataract surgery in nanophthalmic eyes.

Trial registration

ClinicalTrails.gov, Trial registration number: NCT02182921, Registered 8 July 2014.

Cataract surgery and intraocular pressure in glaucoma

PURPOSE OF REVIEW

To review the current literature on the relationship between cataract extraction and intraocular pressure (IOP).

RECENT FINDINGS

Cataract extraction can be an effective IOP lowering treatment for open and closed angle glaucoma as well as ocular hypertension. In comparative trials studying novel micro-invasive glaucoma surgeries in open angle glaucoma, the control group undergoing cataract extraction alone routinely achieved significant reductions in IOP and medication use postoperatively. Data from the Effectiveness in Angle Closure Glaucoma of Lens Extraction (EAGLE) trials have demonstrated that lens extraction is more effective at lowering IOP than peripheral iridotomy in patients with angle closure and should be considered as first line therapy. Additionally, patients in the ocular hypertension treatment study who underwent cataract extraction over the course of follow-up demonstrated significant IOP lowering sustained over 3 years.

SUMMARY

Cataract extraction is an effective method to lower IOP in patients with glaucoma. Pressure lowering is more significant in eyes with narrow angles and those with higher baseline IOP levels. In eyes with angle closure, phacoemulsification alone can lower IOP, but when combined with GSL it may be even more effective. Recent large multicenter randomized trials have further elucidated the benefit of standalone cataract extraction to treat mild to moderate primary open angle glaucoma. Prospective and longitudinal studies that systematically investigate the variables that may influence degree and duration of IOP lowering post cataract extraction are lacking.