The role of lens extraction in the current management of primary angle-closure glaucoma

Trikha, Sameer; Perera, Shamira A.; Husain, Rahat; Aung, Tin

doi:10.1097/icu.0000000000000128

Cited by 37 publications

(22 citation statements)

References 36 publications

(35 reference statements)

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“…Patients with acute attacks of angle closure (a rare presentation of the disease) were excluded in our trial, and thus studies evaluating lens extraction for acute attacks are not comparable 2526 A review conducted by Trikha et al 8 has suggested that lens extraction for PACG is associated with better IOP control, reduced complication rates and reduced need for IOP-controlling medications compared to other relevant treatments. These findings are in keeping with ours.…”

Section: Discussionmentioning

confidence: 99%

Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: an economic evaluation based on data from the EAGLE trial

et al. 2017

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ObjectiveTo investigate the cost-effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care.DesignCost-effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed-up for 36 months, and data on health service usage and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5-year and 10-year time horizon.Setting22 hospital eye services in the UK.PopulationMales and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC).InterventionsLens extraction compared to standard care (ie, laser iridotomy followed by medical therapy and glaucoma surgery).Outcome measuresCosts of primary and secondary healthcare usage (UK NHS perspective), quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for lens extraction versus standard care.ResultsThe mean age of participants was 67.5 (8.42), 57.5% were women, 44.6% had both eyes eligible, 1.4% were of Asian ethnicity and 35.4% had PAC. The mean health service costs were higher in patients randomised to lens extraction: £2467 vs £1486. The mean adjusted QALYs were also higher with early lens extraction: 2.602 vs 2.533. The ICER for lens extraction versus standard care was £14 284 per QALY gained at three years. Modelling suggests that the ICER may drop to £7090 per QALY gained by 5 years and that lens extraction may be cost saving by 10 years. Our results are generally robust to changes in the key input parameters and assumptions.ConclusionsWe find that lens extraction has a 67–89% chance of being cost-effective at 3 years and that it may be cost saving by 10 years.Trial registration numberISRCTN44464607; Results.

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Section: Discussionmentioning

confidence: 99%

Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: an economic evaluation based on data from the EAGLE trial

et al. 2017

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“…A recent publication in Medscape by Laurie Barclay, M.D. "Clear-Lens Extraction May Be Best for Primary Glaucoma" pointed out that clear lens extraction was more effective and more cost-effective than LPI [8] IOP spikes post-op while CE eyes achieved lower IOP and deeper ACD [9,10].…”

Section: Discussionmentioning

confidence: 99%

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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“…[27] This explains the benefit of lens extraction in PAC eyes without permanent trabecular damage with repeated episodes of irido-corneal contact. [28,29] Newer imaging techniques have now shifted the focus on the lens vault rather than axial lens thickness. [29,30] The importance of iris configuration has been renewed with the use of modern angle imaging systems with due recognition of varied course of eyes with plateau iris after LPI.…”

Section: Discussionmentioning

confidence: 99%

Angle Closure Scoring System (ACSS)-A Scoring System for Stratification of Angle Closure Disease

et al. 2016

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PurposeTo evaluate the angle closure scoring system (ACSS) for stratifying primary angle course disease.MethodsThis observational cross sectional institutional study included patients with primary open angle glaucoma suspects (n = 21) and primary angle closure disease (primary angle closure, PAC, n = 63 and primary angle course glaucoma, PACG, n = 58 (defined by International society of Geographical and Epidemiological Ophthalmology, ISGEO). Two independent examiners blinded to clinical details, graded good quality pre-laser goniophotographs of the patients incorporating quadrants of peripheral anterior synechieae (PAS), non-visibility of posterior trabecular meshwork (PTM) and blotchy pigments (ranging from 1–4 quadrants), iris configuration, angle recess (sum of above depicting ACSSg) and lens thickness/axial length ratio (LT/AL), cup disc ratio and baseline intraocular pressure (IOP) to give total score (ACSSt).ResultThere were significant differences in ACSSg scores within the same ISGEO stage of PAC and PACG between eyes that required nil or >1medicines after laser iridotomy, p<0.001. The ACSSg was associated with need for >1 medicines in both PAC and PACG eyes, p<0.001. An ACSSg score>12 and 14 in PAC (odds ratio = 2.7(95% CI-1.7–5.9) and PACG (Odds ratio = 1.6(95%CI-1.19–2.2) predicted need for single medicines while ACSSg scores >14 and 19 predicted need for ≥2 medicines in PAC and PACG eyes, respectively. The LT/Al ratio, IOP score or cup disc score did not influence the need for medical treatment independently.ConclusionThe ACSS can be a useful clinical adjunct to the ISGEO system to predict need for medicines and prognosticate each stage more accurately.

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The role of lens extraction in the current management of primary angle-closure glaucoma

Abstract: Good outcomes in terms of long-term IOP control have been found following lens extraction for PACG. Lens extraction should be considered in patients with PACG, especially with hyperopia, or a thick and anteriorly vaulted lens.

Cited by 37 publications

References 36 publications

Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: an economic evaluation based on data from the EAGLE trial

Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: an economic evaluation based on data from the EAGLE trial

Cataract extraction as primary treatment for narrow angle glaucoma

Angle Closure Scoring System (ACSS)-A Scoring System for Stratification of Angle Closure Disease

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