Phacoemulsification versus peripheral iridotomy in the management of chronic primary angle closure: long-term follow-up

Abstract

Primary angle closure occurs as a result of crowded anterior segment anatomy, causing appositional contact between the peripheral iris and trabecular meshwork, thereby obstructing aqueous outflow. Several studies highlight the role of the crystalline lens in its pathogenesis. The objective of this work is to compare the long-term efficacy of phacoemulsification versus laser peripheral iridotomy (LPI) in the management of chronic primary angle closure (CPAC). Prospective case-control study with 30 eyes of 30 patients randomly divided in two groups: 15 eyes in the LPI group and 15 eyes in the IOL group. Patients in the LPI group underwent LPI using argon and Nd:YAG laser. Patients in the IOL group underwent phacoemulsification with posterior chamber intraocular lens (IOL) implantation. Examinations before and after the procedure included gonioscopy, Goldmann applanation tonometry, and anterior chamber evaluation using the Pentacam rotating Scheimpflug camera. The mean follow-up time was 31.13 ± 4.97 months. There was a statistically significant reduction in the intraocular pressure (IOP) and number of anti-glaucoma medications (p \ 0.01) only in the IOL group. Anterior chamber depth, angle, and volume were all higher in the IOL group (p \ 0.01) at the end of the follow-up period. Phacoemulsification with posterior chamber IOL implantation results in a higher anterior chamber depth, angle, and volume, when compared to LPI. Consequently, phacoemulsification has greater efficacy in lowering IOP and preventing its long-term increase in patients with CPAC and cataract.

Meta‐Analysis of Phacoemulsification and Laser Peripheral Iridotomy in the Treatment of Primary Angle‐Closure Glaucoma

“…A total of four studies [ 22 , 23 , 25 , 28 ] recorded the ACD of the two groups three months after the operation. There was significant heterogeneity between the studies ( P < 0.00001 and I 2 = 99%), so the random effect model was used for analysis.…”

“…Fifty-four full-text articles were identifed as potentially relevant for analysis in terms of the inclusion and exclusion criteria. Finally, eight studies [22][23][24][25][26][27][28][29] involving 894 eyes were included in the analysis. Tere was no signifcant diference in age, gender composition ratio, and IOP before treatment between the two groups (P > 0.05).…”

“…Te results are displayed in Figure 2. Six studies [23,[25][26][27][28][29] mentioned the random sequence generation scheme, indicating a low risk of bias. Two studies [22,24] were rated as uncertain because the random sequence generation scheme was not specifed in the text.…”

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

“…In addition, prior studies have shown that PAC spectrum eyes have more anteriorly positioned crystalline lenses than normal eyes [13–15]. Cataract extraction (CE) with a thin intraocular lens (IOL) implantation may open the angle by deepening the ACA, repositioning the ciliary processes posteriorly, and reducing IOP, making it a potentially viable surgical treatment for PAC spectrum patients [7, 16]. …”

Glaucoma and cataract: the effect of the phacoemulsification procedures and the combined procedures on the intraocular pressure

“…Ten korzystny stosunek ryzyka do korzyści sprawia, iż operacja usunięcia zaćmy jest potencjalnie skuteczną strategią leczenia u pacjentów ze współistniejącymi jaskrą i zaćmą, zarówno jako pojedynczy zabieg, jak i łączony z zabiegiem przeciwjaskrowym (MIGS, minimally invasive glaucoma surgeries). Dodatkowo zabieg usunięcia zaćmy w większości przypadków ma udowodnione znaczenie w obniżaniu IOP, dlatego też rośnie przekonanie, iż sama fakoemulsyfikacja zabieg uSunięcia zaćMy a iOp Wpływ zabiegu usunięcia zaćmy na zmiany w IOP był i nadal jest tematem wielu badań skupiających się na różnych typach jaskry[6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Dyskusyjne pozostaje jednak, jak silne są: ta zależność, efekt oraz znaczenie kliniczne.…”