Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial

Azuara‐Blanco, Augusto; Burr, Jennifer; Ramsay, Craig R; Cooper, David; Foster, Paul J.; Friedman, David S.; Scotland, Graham; Javanbakht, Mehdi; Cochrane, Claire; Norrie, John

doi:10.1016/s0140-6736(16)30956-4

Cited by 427 publications

(309 citation statements)

References 20 publications

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“…Clear-lens extraction was performed on 208 and 211 had standard care of LPI. Clear-lens extraction showed greater efficacy and was more cost-effective than LPI [12]. Medicare allowable for LPI in our ASC is $394.93 and $1406.13 for CE.…”

Section: Discussionmentioning

confidence: 73%

Cataract extraction as primary treatment for narrow angle glaucoma

Patel¹,

Findley²,

Peck³

2017

New Front Ophthalmol

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Purpose: To compare the increase in anterior chamber depth (ACD) after cataract extraction/ lensectomy (CE) vs. laser peripheral iridotomy (LPI) in patients with narrow angles (NA) and narrow angle glaucoma (NAG). Effect on intraocular pressure (IOP) and cost was also evaluated. Materials and methods:The Lenstar was used to measure ACD prior to and after cataract extraction and prior to and after LPI in patients with narrow angles. Fifty-four (54) eyes with narrow angles underwent CE and eighteen (18) eyes underwent LPI. Three (3) eyes had LPI with subsequent CE. Pre-and post-surgical IOP were also measured. Results:The mean ACD in eyes undergoing LPI was 2.74 mm before and 2.81 mm after surgery. Mean ACD in eyes undergoing CE was 2.54 mm before and 4.12 mm after surgery. In patients undergoing LPI and subsequent CE mean ACD measured 2.65 mm before LPI, 2.67mm after LPI and 3.92mm after CE. Mean IOP was 21 mmHg before LPI and 18 mmHg after LPI. Mean IOP was 17 mmHg before CE and 15mmHg after C.E. Conclusion:Mean ACD increases significantly more after CE than LPI and should be considered as a primary treatment for patients with NAG and NA in danger of closure.

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Section: Discussionmentioning

confidence: 73%

Cataract extraction as primary treatment for narrow angle glaucoma

Patel¹,

Findley²,

Peck³

2017

New Front Ophthalmol

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“…Significantly fewer patients in this group needed any treatment to control IOP and fewer needed glaucoma medications than patients who received standard care. The authors suggested that clear lens extraction should be considered as an option for first-line treatment [20]. Economic findings from the EAGLE study indicated that lens extraction has a 67-89% chance of being cost effective at three years (fewer subsequent procedures including repeat LPI, lens extraction or glaucoma surgery, and lower medication use), and it may be cost saving by 10 years [21].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of efficacy of lens extraction for intraocular pressure reduction in eyes with primary angle closure glaucoma and primary angle closure

2017

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introduCtion. The purpose of the study was to evaluate the intraocular pressure (IOP) lowering effect of lens removal in eyes with primary angle closure glaucoma (PACG) and primary angle closure (PAC). MATERIALS AND METHODS. This study was a retrospective analysis of 114 eyes of 97 patients (83 women, 14 men; mean age 69.9 years) with PACG and PAC treated with lens extraction. Outcome measures: age, gender, visual acuity, IOP reduction over time, preoperative and postoperative number of IOP-lowering medications, axial length, intraocular lens (IOL) power, requirement for additional anti-glaucoma operations, and complications. Patients were divided into three groups: 1) patients with PAC (22 eyes) with mean follow-up 12.2 months; 2) patients with PACG with a history of previous acute angle closure (AAC) (39 eyes) with mean follow-up 15.4 months; and 3) patients with PACG without a history of previous AAC (53 eyes), with mean follow-up 13.5 months. Laser iridotomy was performed in all treated eyes prior to the surgery. RESULTS. In the group with PAC mean IOP was reduced from 42.2 ± 15.4 mm Hg (mean ± SD) under 2.6 IOP-lowering medications to 20.2 ± 10.4 mm Hg under 1.1 IOP-lowering medications (mean IOP reduction 52.1%). In the group with PACG with a history of previous AAC mean IOP was reduced from 29.0 ± 15.7 mm Hg under 2.1 IOP-lowering medications to 17.0 ± 7.5 mm Hg under 0.7 IOP-lowering medications (mean IOP reduction 41.3%). In the group with PACG without a history of previous AAC (53 eyes) mean IOP was reduced from 22.8 ± 8.0 mm Hg under 1.75 IOP-lowering medications to 18.8 ± 7.4 mm Hg under 1.5 IOP-lowering medications (mean IOP reduction 17.5%). In all three groups statistically significant improvement of visual acuity as a result of surgery was observed. There were no statistically significant differences between the three groups with regard to AXL or IOL power. Intraoperative complications were noticed in eight cases, and postoperative complications were noticed in four cases. The number of anti-glaucoma medications was reduced, but 17 eyes needed additional anti-glaucoma procedures. CONCLUSIONS. Lens extraction in eyes with PACG and PAC resulted in significant IOP reduction in all groups. The most pronounced IOP reduction was achieved in the group with PAC, where lens extraction was performed up to 60 days from AAC. Visual acuity was significantly improved as a result of surgery in all three study groups.

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“…Liegt keine visuell signifikante Katarakt vor, ist hingegen umstritten, ob und wann eine solche Intervention durchgeführt werden sollte [47]. Eine aktuelle randomisierte, kontrollierte Studie ergab, dass die frühe Linsenextraktion sinnvoll sein könnte, wenn die Linse eine signifikante Komponente des Winkelverschlusses darstellt [48]. Der Verlust der Akkommodation in diesem Szenario, insbesondere bei vergleichsweise jungen Patienten, muss hierbei berücksichtigt werden.…”

Section: Therapieoptionenunclassified

“…Hierzu zählen ein hoher AID, ein flacher Vorderkammerraum, das Floppy-Iris-Syndrom nach Irisischämie, posteriore Synechien, eine massige Linse, schlaffe Zonulafasern und das Risiko eines malignen Glaukoms [48]. Bei einem unerfahrenen Operateur kann die Linsenextraktion in diesen Augen oft zu potenziell verheerenden Komplikationen führen, einschließlich einer posterioren Kapselruptur, eines abstürzenden Linsenkerns oder einer suprachoroidalen Blutung.…”

Section: Therapieoptionenunclassified

Chirurgische Behandlung des Engwinkelglaukoms

Lim¹,

Aquino²,

Chew³

2018

Kompass Ophthalmol

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Fortschritte in der Bildgebung des vorderen Segments haben neue Erkenntnisse für ein besseres Verständnis der verschiedenen Mechanismen des Engwinkelglaukoms (EWG) geliefert. Diese Entwicklung ist von großer Bedeutung für eine gute Entscheidungsfindung bei Patienten mit EWG, die eine adäquate Therapie benötigen. Das chirurgische Management des EWG ist nach wie vor ein integraler Bestandteil der Patientenversorgung bei Glaukom. Die spezielle Anatomie des Auges mit Winkelverschluss und das geringe Maß an verfügbarer objektiver Evidenz für die Wirksamkeit der verschiedenen chirurgischen Behandlungsoptionen stellen Glaukomchirurgen vor Herausforderungen. Übersetzung aus Dev Ophthalmol. Basel, Karger, 2017, vol 59, pp 147-154 (DOI: 10.1159/000458493)

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Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial

Abstract: Medical Research Council.

Cited by 427 publications

References 20 publications

Cataract extraction as primary treatment for narrow angle glaucoma

Cataract extraction as primary treatment for narrow angle glaucoma

Evaluation of efficacy of lens extraction for intraocular pressure reduction in eyes with primary angle closure glaucoma and primary angle closure

Chirurgische Behandlung des Engwinkelglaukoms

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