The Role of Automated Peripheral Iridectomy Combined with Phacoemulsification and Mini Ex-PRESS Shunt Implantation in Patients with Chronic Angle Closure Glaucoma

Abstract

Purpose To evaluate the role of automated peripheral iridectomy as an adjunctive tool combined with phacoemulsification and ExPRESS shunt implantation in management of cases with chronic angle closure glaucoma. Setting Magrabi eye hospital. Methods This prospective study included 22 eyes of 22 patients with chronic angle closure glaucoma and cataract who underwent Ex-PRESS shunt implantation, cataract extraction and surgical peripheral iridectomy at the site of shunt implantation in the period between January 2018 and April 2020. Results After surgery, the mean IOP was 11.3±1.2 mm Hg, 14.5±1.6 mm Hg, 14.8±2.1 mm Hg, 15.3±1.9 mm Hg and 17.4±1.8 mm Hg at 7 days, 1 month, 3 months, 6 months and 12 months, respectively. All postoperative IOP was significantly lower compared with preoperative IOP (P = 0.001). There was a significant decrease in the number of medications required after surgery. The baseline mean number of medications was 3.4±0.02 (range from 1 to 4), while postoperatively the mean number of medications decreased to 0.7±0.01 at 12 months (P < 0.01). The qualified success rate was 6/22 eyes, and the complete success rate was 16/22 (72.7%) at 12 months, respectively. Conclusion The combined phacoemulsification and Ex-PRESS shunt implantation with automated peripheral iridectomy is an effective and safe procedure to treat chronic angle closure glaucoma.