The role of clear lens extraction in angle closure glaucoma

Vasile Potop, Catalina Corbu, Vasile Potop, Catalina Corbu

Abstract

Clear lens extraction can be considered a therapeutic option in angle closure glaucoma (ACG). Even if it does not represent the first choice of treatment, it can be taken into consideration when the topical treatment does not control the intraocular pressure (IOP) and iridotomy does not have a positive effect on the angle closure, especially in appositional angle closure when biometry or ultrabiomicroscopy (UBM) show lens involvement. In angle closure glaucoma, clear lens extraction represents an etiological treatment that takes into account the role of the lens in the pathogenesis of the disease. If we ignore it and we choose a filtrating surgery as therapeutic option we can end up with complications such as prolonged athalamia, corneal damage and lens opacification that will eventually require cataract surgery, but performed late and with higher risks. Before performing a filtrating surgery in ACG, we should take an UBM. We also need to choose the best moment to perform surgery, after topical treatment and iridotomy have been tested, but before trabecular damage appears.

Keywords: angle closure glaucoma; occult phacomorphic glaucoma; phacoemulsification.

References

    1. Quigley H, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90:262–267.
    1. Foster PJ, Oen FT, Machin D, et al. The prevalence of glaucoma in Chinese residents of Singapore: a cross- sectional population survey of the Tanjong Pagar district. Arch Ophthalmol. 2000;118:1105–1111.
    1. Douglas GR, Drance SM, Schulzer M. The visual field and nerve head in angle-closure glaucoma. A comparison of the effects of acute and chronic angle closure. Arch Ophthalmol. 1975;93:409–411.
    1. Dhillon B, Chew PT, Lim AŞ. Field loss in primary angle closure glaucoma. Asia Pac J Ophthalmol. 1990;2:85–87.
    1. Rosman M, Aung T, Ang LP, et al. Chronic angle-closure with glaucomatous damage: Long-term clinical course in a North American population and comparison with an Asian population. Ophthalmology. 2002;109:2227–2231.
    1. Lee YH, Kim CS, Hong SP. Rate of visual field progression în primary open-angle glaucoma and primary angle-closure glaucoma. Korean J Ophthalmol. 2004;18:106–115.
    1. Quigley HA, Congdon NG, Friedman DG. Glaucoma in China (and worldwide): changes in established thinking will decrease preventable blindness. Br J Ophthalmol. 2001;85:1271–1272.
    1. Friedman DSV. R.N. Consensus on Angle-closure and Angle-closure Glaucoma. AIGIS/WGA Consensus Series. 2008
    1. Yip LW, Aquino MC, Chew PT. Measurement of anterior lens growth after acute primary angle-closure glaucoma. Can J Ophthalmol. 2007 Apr;42(2):321–322.
    1. Heys JJ, Barocas VH, Taravella MJ. Modeling passive mechanical interaction between the aqueous humor and iris. J Biomech Eng. 2001;123:540–547.
    1. Lowe RF. Causes of shallow anterior chamber in primary angle-closure glaucoma. Am J Ophthalmol. 1989;67:87–93.
    1. Lim KJ, Hyung SM, Youn DH. Ocular dimensions with aging în normal eyes. Korean J Ophthalmol. 1992;6:19–23.
    1. Friedman DS, Gazzard G, Foster P, et al. Ultrasonography biomicroscopy, scheimpflug photography, and novel pro-vocative tests in contralateral eyes of Chinese patients initially seen with acute angle closure. Ophthalmology. 2003;121:633–642.
    1. Jahn CE. Lowering intraocular pressure by phacoemulsification and posterior chamber lens implantation. Ophthalmology. 1995;92:560–563.
    1. Lam DS, Leung DY, Tham CC, et al. Randomized trial of early phacoemulsification versus peripheral iridotomy to prevent intraocular pressure rase after acute primary angle closure. Ophthalmology. 2008;115:1134–1140.
    1. Vizzeri G, Weinreb RN. Cataract surgery and glaucoma. Curr Opin Ophthalmol. 2010;21:20–24.
    1. Tham CC 1, Kwong YY, Leung DY, et al. Phacoemulsification versus combined phacotrabeculectomy in medically uncontrolled chronic angle closure glaucoma with cataracts. Ophthalmology. 2009;116:725–731.
    1. Lai JS, Tham CC, Chan JC. The clinical outcomes of cataract extraction by phacoemulsification in eyes with primary angle closure glaucoma. J Glaucoma. 2006;15:47–52.
    1. Liu CJ, Cheng CY, Ko YC, Lau LI. Determinants of long-term intraocular pressure after phacoemulsification in primary angle-closure glaucoma. J Glaucoma. 2011;20:566–570.
    1. Huang G, Gonzalez E, Lee R, et al. Association of biometric factors with anterior chamber angle widening and intraocular pressure reduction after uneventful phacoemulsification for cataract. J Cataract Refract Surg. 2012;38:108–116.
    1. Husain R, Gazzard G, Aung T, et al. Iniţial management of acute primary angle closure: a randomized trial comparing phacoemulsification with laser peripheral iridotomy. Ophthalmology. 2012;119:2274–2281.
    1. Tham CC 1, Kwong YY, Leung DY, et al. Phacoemulsification vs phacotrabeculectomy în chronic angle-closure glaucoma with cataract: complications. Arch Ophthalmol. 2010;128:303–311.
    1. Tham CC 1, Leung DY, Kwong YY, et al. Effects of phacoemulsification versus combined phaco-trabeculectomy on drainage angle status în primary angle closure glaucoma (PACG) Glaucoma. 2010;19:119–123.
    1. Tham CC, Kwong YY, Baig N, et al. Phacoemulsification versus trabeculectomy in medically uncontrolled chronic angle-closure glaucoma without cataract. Ophthalmology. 2013;120:62–67.
    1. Wu W, Dawson DG, Sugar A, et al. Cataract surgery in patients with nanophthalmos: results and complications. J Cataract Refract Surg. 2004;30:584–590.
    1. Fleck BW, Wright E, Fairley EA. A randomised prospective comparison of operative peripheral iridectomy and Nd:YAG laser iridotomy treatment of acute angle closure glaucoma: 3 year visual acuity and intraocular pressure control outcome. Br J Ophthalmol. 1997;81(10):884–888.
    1. Ho T, Fan R. Sequential argon-YAG laser iridotomies in dark irides. Br J Ophthalmol. 1992;76(6):329–331.
    1. Chen PP, Lin SC, Junk AK, Radhakrishnan S, Singh K, Chen TC. The Effect of Phacoemulsification on Intraocular Pressure in Glaucoma Patients - A Report by the American Academy of Ophthalmology. Ophthalmology. 2015;122:1294–1307.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir