Ten-Year Clinical Outcomes of Acute Primary Angle Closure Randomized to Receive Early Phacoemulsification Versus Laser Peripheral Iridotomy

Abstract

Purpose: To compare the 10-year clinical outcomes of eyes with acute primary angle closure (APAC) randomized to receive either early phacoemulsification or laser peripheral iridotomy (LPI). Methods: Sixty-two APAC patients, who underwent either early phacoemulsification (phaco group) or laser peripheral iridotomy (LPI group) in a previous randomized controlled trial, were invited for assessment 10 years after the interventions. The results of the 2 groups were compared. Results: Forty of 62 patients (64.5%; 19 in phaco group and 21 from LPI group) were examined. None of them underwent additional glaucoma procedure but 15 (71.4%) patients in the LPI group received lens extraction before this assessment. The mean follow-up duration was 10.7±0.7 years. The phaco group used less medication (0.16±0.37 vs. 0.76±1.09 bottle per eye, P=0.028), had less extensive anterior synechiae (120.0±116.12 vs. 244.3±139.8 degree, P=0.010), and greater mean Shaffer gonioscopy grading (1.79±0.84 vs. 1.40±0.87; P=0.021) than the LPI group. Five eyes had persistent intraocular pressure elevation of >21 mm Hg in 2 consecutive visits and 4 eyes had blindness (best-corrected visual acuity worse than 6/60 and/or central visual field of <20 degree) in the LPI group, compared with none in the phaco group (P=0.022 and 0.045, respectively). There was no significant difference in the mean intraocular pressure, best-corrected visual acuity, and the number of eyes with visual field progression. Conclusion: At 10 years, APAC eyes that underwent early phacoemulsification required less medication, less peripheral anterior synechiae, lower incidence of intraocular pressure elevation and a lower incidence of blindness compared with APAC eyes that underwent initial LPI.

Predictors of long‐term visual field outcome after an episode of acute primary angle closure

“…In a more recent follow‐up study of the same cohort, they found that patients undergoing clear‐lens extraction were 10 times more likely to achieve good IOP control postoperatively without the need for topical therapy or surgery for up to 3 years 32 . Although the role of lens extraction as a primary treatment might still be questionable, especially in younger patients who can still accommodate and those with modestly raised IOP, it seems that early lens extraction is beneficial in terms of improved patient‐reported quality of life, better IOP control, and reduced need for glaucoma medication for patients who experienced an episode of APAC 33,34 …”

Comparison of Lens Extraction Versus Laser Iridotomy on Anterior Segment, Choroid, and Intraocular Pressure in Primary Angle Closure Using Machine Learning

“…55 There are many studies devoted to the advantages of LE over LPI in acute primary closed angle. 56,57 The insufficiency of LPI for the treatment of acute primary closed angle is proven by the fact that 30% of patients subsequently require trabeculectomy due to IOP decompensation. 58 In addition, late LE due to the formation of goniosynechia in the eyes that had previously undergone trabeculectomy 59 or LPI in subsequent selective laser trabeculoplasty 60 does not lead to a decrease in ITC.…”

Long-term effect of lens extraction on anterior angle morphology in primary angle closure glaucoma

“…In another study, 36 PACG patients were followed up for more than two years after LE, and 69.4% of these patients showed progression in optic nerve damage [23]. Moreover, Chan et al [24] evaluated 19 patients with acute primary angle closure who underwent early phacoemulsi cation after 10 years and found that these patients had a mean anterior synechiae range of 120.0°±116.12. We speculate that this discrepancy may relate to different mechanisms of angle-closure.…”