Changes in Intraocular Pressure and Angle Status After Phacoemulsification in Primary Angle Closure Hypertension

Abstract

Purpose: To study the change in intraocular pressure (IOP) and angle status after phacoemulsification in a cohort of primary angle closure hypertension (PACHT) patients. Setting: Tertiary Eye Care, India. Design: Prospective interventional case-series. Methods: Case-series of 18 eyes of 18 patients. Preoperative biometry including axial length, anterior chamber depth (ACD), lens thickness, and central corneal thickness were studied. Preoperative and postoperative IOP, number of topical glaucoma medications, angle swept source optical coherence tomography (SS-OCT) parameters of nasal and temporal angle opening distance, trabecular iris space area, scleral spur angle, lens vault and circumferential iridotrabecular contact (ITC) were studied and their correlations derived. Results: The mean preoperative IOP, 31±6 mm Hg, decreased to 14±1 mm Hg at 6-months postoperative period, P<0.001, a fall by 58±14%. The number of glaucoma medications reduced from 4(3-5) to 2(1-3), P<0.001. All SS-OCT studied parameters denoted significant angle widening postsurgery. The ITC% reduced from 52(16-100) to 19(0-97), P<0.001. The preoperative ITC showed moderate to strong correlation with all preoperative nasal and temporal angle parameters. It also showed moderate positive correlation with percentage fall in IOP at 1-month postoperative period. The preoperative ACD showed significant negative correlation with preoperative and postoperative ITC. Conclusions: PACHT patients benefit significantly from cataract surgery with marked angle widening, IOP reduction and a decrease in the number of glaucoma medications. The SS-OCT derived circumferential iridotrabecular contact index can be used as the single best parameter to indicate the preoperative angle status and predict postoperative change in IOP, as against the numerous single section measured angle parameters.

Effect of Multifocal Intraocular Lens on Contrast Sensitivity in Primary Angle-Closure Patients

“…Our study showed improvement in postoperative visual acuity, and there was no signi cant difference in uncorrected distance visual acuity between the MIOL and mIOL groups. This same nding was previously reported from a study that compared MIOLs and mIOLs in nonglaucomatous eyes [13]. The present study found the postoperative CS to be highest at 3 CPD in the mIOL group, and at 6 CPD in the MIOL group.…”

“…Improvement in glaucoma control after cataract surgery was reported, and the observed improvement was found to be more pronounced in angle-closure than in open-angle glaucoma [7,13]. Our study demonstrates the positive effect of cataract surgery in PAC/PACG, including deepening of the ACD and IOP reduction.…”

“…It was not until the 1980s that MIOLs started being used for cataract surgery. Several studies con rmed that MIOLs provide good near and distance visual acuity, more spectacle independence, and high patient satisfaction [13]. In contrast, MIOLs can also produce unwanted optical effects, including halos, glare, and decreased CS [10,14,15].…”

“…Our study demonstrates the positive effect of cataract surgery in PAC/PACG, including deepening of the ACD and IOP reduction. Deepening of the ACD and relief of the crowding angle were hypothesized to result in improvement of aqueous out ow with subsequent IOP reduction [13,20]. It should be noted that we included only PAC and PACG with mild glaucomatous optic neuropathy and well-controlled IOP without signi cant visual eld loss in order to reduce the likelihood of VF progression after cataract surgery.…”

“…However, those previous studies investigated the performance of previous spherical MIOLs. With the introduction of aspheric MIOLs, some of the loss of CS may be ameliorated [13]. The mIOLs used in this study were aspheric IOLs, which reduce spherical aberration by counteracting corneal sphericity that increases with aging.…”