Comparing Laser Peripheral Iridotomy to Cataract Extraction in Narrow Angle Eyes Using Anterior Segment Optical Coherence Tomography

Abstract

PurposeTo evaluate the changes in anterior chamber angle (ACA) parameters in primary angle closure (PAC) spectrum eyes before and after cataract extraction (CE) and compare to the changes after laser peripheral iridotomy (LPI) using anterior segment optical coherence tomography (ASOCT).MethodsTwenty-eight PAC spectrum eyes of 18 participants who underwent CE and 34 PAC spectrum eyes of 21 participants who underwent LPI were included. ASOCT images with 3-dimensional mode angle analysis scans were taken with the CASIA SS-1000 (Tomey Corp., Nagoya, Japan) before and after CE or LPI. Mixed-effect model analysis was used to 1) compare best-corrected visual acuity, intraocular pressure, and ACA parameters before and after CE; 2) identify and estimate the effects of potential contributing factors affecting changes in ACA parameters; and 3) compare CE and LPI treatment groups.ResultsThe increase in average angle parameters (TISA750 and TICV750) was significantly greater after CE than LPI. TICV750 increased by 102% (2.114 [±1.203] μL) after LPI and by 174% (4.546 [± 1.582] μL) after CE (P < 0.001). Change of TICV750 in the CE group was significantly affected by age (P = 0.002), race (P = 0.006), and intraocular lens power (P = 0.037).ConclusionsCE results in greater anatomic changes in the ACA than LPI in PAC spectrum eyes. ASOCT may be used to follow anatomic changes in the angle after intervention.

Long-term Intraocular Pressure Elevation after Primary Angle Closure Treated with Early Phacoemulsification

“…It has been reported that cataract surgery alone decreases IOP to some extent [ 11 12 ]. The degree of IOP reduction differs depending on the type of glaucoma, and many studies have shown that phacoemulsification can improve IOP control in eyes with APAC [ 4 5 6 7 8 ]. However, APAC patients treated with phacoemulsification do not always exhibit a decrease in IOP.…”

“…Meanwhile, the lens plays an important role in the pathogenesis of APAC. The lens may narrow the angle by pushing the peripheral iris forward, and this effect will be more significant if the lens is affected by cataracts [ 4 5 ]. Hence, lens extraction in acute angle closure has had promising results and may result in less long-term peripheral anterior synechia (PAS) formation [ 6 7 ].…”

Has the EAGLE landed for the use of clear lens extraction in angle-closure glaucoma? And how should primary angle-closure suspects be treated?

“…The study found the angle width parameters were significantly increased following cataract extraction compared to LPI. 59 A randomized trial by Lam et al examined 62 Chinese cataract patients who also had suffered acute PAC found that early phacoemulsification was more effective at preventing a future rise in IOP than was LPI. 60 Another RCT conducted by Husain et al allocated 37 participants to either LPI or phacoemulsification for patients with early acute angle closure with co-existing cataract.…”

Laseriridotomie – nur bei akuter Engwinkelsituation?

“…Bei sehr engem Kammerwinkel, höherer Hyperopie oder seniler Katarakt mit einer Zunahme der Linsendicke kommt ein Eingriff an der kristallinen Linse infrage, um die anatomischen Verhältnisse positiv zu beeinflussen und einen Winkelblock aufzuheben oder einem solchen vorzubeugen. Eine Entscheidung, die bei bereits bestehender Presbyopie sowie beginnender oder fortgeschrittener Linsentrübung zunehmend leichter fällt, am jungen Auge aber nur als Ultima Ratio infrage kommt [33,34].…”