Early Phacoemulsification After Acute Angle Closure in Patients With Coexisting Cataract

Römkens, Hellen C.S.; Beckers, Henny J. M.; Schouten, Jan S.A.G.; Nuijts, Rudy M.M.A.; Berendschot, Tos T. J. M.; Breusegem, Christophe; Webers, Carroll A.B.

doi:10.1097/ijg.0000000000001111

Cited by 7 publications

(5 citation statements)

References 2 publications

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“…The prevalence of APACG in the Asian population is 10.4/100,000 to 12.2/100,000 per year, which is 2 to 5 times higher than that in the European and American populations, [5] and the prevalence is highest in East Asia. [6] APACG episodes were mostly seen in women, [7] which is similar to the findings of the present study. Continuous high IOP leads to increased retinal and optic nerve susceptibility, and the pressure difference between the 2 sides of the lamina cribrosa directly compresses the optic nerve fibers and affects the microcirculation of the optic disc.…”

Section: Discussionsupporting

confidence: 92%

Anterior segment pars plana vitrectomy combined with posterior capsulorhexis, phacoemulsification and trabeculectomy in treatment of medically uncontrolled acute primary angle-closure glaucoma: A retrospective study

Tian

et al. 2022

Medicine

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To explore the clinical efficacy of quadruple surgery (anterior segment pars plana vitrectomy + phacoemulsification + posterior capsulorhexis + intraocular lens (IOL) implantation + trabeculectomy) and dual surgery (phacoemulsification + IOL implantation + trabeculectomy) to treat medically uncontrolled acute primary angle-closure glaucoma (APACG). The clinical data of 44 patients (45 eyes) with APACG treated in the Department of Ophthalmology of Taihe Hospital were retrospectively analyzed. They were divided into 2 groups based on quadruple surgery and dual surgery. There were 20 patients (20 eyes) underwent quadruple surgery in group A. And there were 24 patients (25 eyes) dual surgery in group B. The changes in intraocular pressure (IOP), visual improvement, and complications were observed between the 2 groups preoperatively and 1 month, 3 months, and 6 months postoperatively. Preoperative best corrected visual acuity (BCVA) was the influencing factor of postoperative BCVA at 1 month, 3 months and 6 months. Before surgery, the mean IOP of group A was significantly higher than that of group B (P < .001), and no significant difference was found in the BCVA, age, gender, eyes, axial length (AL), anterior chamber depth (ACD) (P BCVA = 0.12, P age = 0.76, P eyes = 0.20, P gender = 0.37, P AL = 0.94, P ACD = 0.08). On comparison at postoperative 1week, there was no significant difference in the IOP and BCVA between the 2 groups (P IOP = 0.64, P BCVA = 0.66). The mean IOP of group A was significantly lower than that of group B 1 month, 3 months, and 6 months postoperatively (P 1month = 0.002, P 3months < 0.001, P 6months < 0.001). The degree of visual acuity recovery was significantly higher in group A at 1 month, 3 months, and 6 months postoperatively (P 1month = 0.03, P 3months = 0.02, P 6months = 0.02). During treatment, the incidence of complications in group B was significantly higher than that in group A (P < .01). The clinical efficacy of anterior segment pars plana vitrectomy combined with posterior capsulorhexis, phacoemulsification, and trabeculectomy elicits clinical safety in treating medically uncontrolled APACG. It has remarkable effects and leads to a significant decrease in the occurrence of complications.Abbreviations: ACD = anterior chamber depth, AL = axial length, APACG = acute primary angle-closure glaucoma, BCVA = best corrected visual acuity, IOL = intraocular lens, IOP = intraocular pressure, OCT = optical coherence tomography.

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Section: Discussionsupporting

confidence: 92%

Anterior segment pars plana vitrectomy combined with posterior capsulorhexis, phacoemulsification and trabeculectomy in treatment of medically uncontrolled acute primary angle-closure glaucoma: A retrospective study

Tian

et al. 2022

Medicine

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“…In the current study, the overall success of long-term IOP control was 95.83% in Group A and 100% in Group B, which is comparable to previous reports [7,8,23]. Four eyes (16.66%) in Group A and five eyes (21.73%) in Group B required medical control following phaco/IOL, which was believed to be associated with preexisting PAS that had not been alleviated after surgery.…”

Section: Kaplan-meier Survival Estimatessupporting

confidence: 84%

“…In our study, there was no significant difference between Groups A and B in the postoperative IOP control, ocular morphological characteristics, and the number of antiglaucoma medications, indicating that phaco/ IOL performed weeks to months after initial LPI did not diminish the effectiveness of phaco in the treatment of acute PAC. Similarly, Römkens et al compared patients operated within a few days or after a few weeks after acute PAC and found no difference in IOP reduction as well as IOP after 3 months of the surgery [23]. Waiting a few months prior to performing phaco enables doctors to treat acute PAC attacks, reducing IOP, inflammation, and corneal edema and assuring successful surgery.…”

Section: Kaplan-meier Survival Estimatesmentioning

confidence: 99%

Early versus Delayed Phacoemulsification and Intraocular Lens Implantation for Acute Primary Angle-Closure

Lin

Huang

et al. 2020

Journal of Ophthalmology

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Purpose. To compare the effects of early phacoemulsification and intraocular lens implantation (phaco/IOL), delayed phaco/IOL after initial laser peripheral iridotomy (LPI), and conventional LPI alone in patients with acute primary angle-closure (PAC). Methods. Patients with acute PAC were included in the study, and those with secondary glaucoma, prior ocular trauma, or other ocular diseases and those who had undergone ocular surgeries previously were excluded. Patients were categorized into three groups: Group A, which underwent primary phaco/IOL after acute PAC; Group B, which underwent LPI initially after acute PAC, followed by phaco/IOL within 6 months; and Group C, which underwent LPI alone. The IOP control success at 12 months as well as changes in ocular characteristics and the number of antiglaucoma medications used after the treatment among the groups were evaluated. Results. Eighty-one eyes were included in the study: 24 eyes in Group A, 23 eyes in Group B, and 34 eyes in Group C. The linear mixed model analysis demonstrated considerable IOP control in Groups A and B. Visual acuity, anterior chamber depth (ACD), and angle width improved significantly in Groups A and B, but not in Group C. The number of antiglaucoma medications used was significantly higher in Group C than in Groups A and B. Conclusions. Patients who underwent phaco/IOL had better IOP control, improved vision, deeper ACD, and wider angle and required less antiglaucoma medications than those who underwent LPI alone. Performing phaco/IOL weeks to months after the initial LPI did not appear to adversely affect outcomes compared with those of early phaco/IOL.

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“…2,11 Phacoemulsi cation is effective in treating APAC to reduce IOP, glaucoma medications, and improve visual acuity. 12 Hence, to further reduce the impact of different surgeries on the ocular microcirculation, we only included APAC eyes treated with cataract extraction and phacoemulsi cation.…”

Section: Introductionmentioning

confidence: 99%

Optical coherence tomography angiography of the macular microcirculation in acute primary angle closure treated with phacoemulsification

et al. 2022

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To measure the changes of macular microcirculation in cases with unilateral acute primary angle closure (APAC) who were managed by phacoemulsi cation. MethodsPatients with unilateral APAC and managed by phacoemulsi cation were enrolled. The contralateral unaffected eyes were served as fellow group, and normal individuals were recruited as control group.Optical coherence tomography angiography (OCT-A) was performed to analyse the macular whole image vessel density (wiVD) and parafoveal vessel density (pfVD). The retinal nerve ber layer (RNFL) and ganglion cell complex (GCC) thicknesses were assessed using spectral-domain optical coherence tomography. ResultsA total of 36 APAC patients and 35 eyes from 35 normal individuals were recruited. In the APAC eyes, the mean wiVD (42.1% ± 3.7%) and pfVD (45.2% ± 3.8%) in the super cial layers (wiVD-SL and pfVD-SL) were both signi cantly reduced, compared to fellow eyes (45.7% ± 3.1%, 48.7% ±3.1%) and control eyes (44.4% ± 4.7%, 47.4% ± 5.1%) (P < 0.05). They were all statistically correlated with RNFL, GCC, visual eld pattern standard deviation (PSD), and mean deviation (MD). ConclusionThe macular OCT-A parameters including wiVD-SL and pfVD-SL were signi cantly reduced in the eyes with APAC compared the fellow unaffected eyes and normal control eyes. They were correlated well with RNFL, GCC, PSD and MD. The macular vessel density parameters may help monitor the progression of APAC.

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Early Phacoemulsification After Acute Angle Closure in Patients With Coexisting Cataract

Cited by 7 publications

References 2 publications

Anterior segment pars plana vitrectomy combined with posterior capsulorhexis, phacoemulsification and trabeculectomy in treatment of medically uncontrolled acute primary angle-closure glaucoma: A retrospective study

Anterior segment pars plana vitrectomy combined with posterior capsulorhexis, phacoemulsification and trabeculectomy in treatment of medically uncontrolled acute primary angle-closure glaucoma: A retrospective study

Early versus Delayed Phacoemulsification and Intraocular Lens Implantation for Acute Primary Angle-Closure

Optical coherence tomography angiography of the macular microcirculation in acute primary angle closure treated with phacoemulsification

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