Korean J Ophthalmol.  2018 Apr;32(2):108-115. 10.3341/kjo.2017.0077.

Long-term Intraocular Pressure Elevation after Primary Angle Closure Treated with Early Phacoemulsification

• Baek SU
• Kim KH
• Lee JY
• Lee KW

• KMID: 2408950
• DOI: http://doi.org/10.3341/kjo.2017.0077

Abstract

PURPOSE
To assess long-term changes in intraocular pressure (IOP) and the development of glaucoma after early phacoemulsification in acute primary angle closure.
METHODS
Retrospective chart review of acute primary angle closure patients treated with phacoemulsification in attack eyes versus fellow eyes. Within a month after the angle closure attack, all subjects underwent cataract surgery and were divided into two groups: group A received cataract surgery on their attack eyes. Group B also received cataract surgery on their fellow eye after phacoemulsification of the attack eyes. Study outcomes were the prevalence of IOP rise (occurrence of IOP >21 mmHg) and the incidence of newly developed glaucoma.
RESULTS
Eighty-nine eyes were included, with 62 attack eyes in group A and 27 fellow eyes in group B. Group A (14 eyes, 22.58%) had a higher cumulative rate of IOP rise than group B (3 eyes, 11.11%) at 12 months (p = 0.001). Newly developed glaucoma was not observed in group B; however, 6 patients in group A developed glaucoma during the 12-month follow-up period (p < 0.001).
CONCLUSIONS
The attack eyes treated with phacoemulsification showed a significantly higher prevalence of IOP rise and newly developed glaucoma than fellow eyes that received phacoemulsification. These findings suggest that there is a possibility of IOP rise and development of glaucoma even when angle closure and successful IOP control have apparently been achieved after phacoemulsification.

Keyword

Angle closure glaucoma; Glaucoma; Intraocular pressure; Phacoemulsification

MeSH Terms

Cataract
Follow-Up Studies
Glaucoma
Glaucoma, Angle-Closure
Humans
Incidence
Intraocular Pressure*
Phacoemulsification*
Prevalence
Retrospective Studies

Reference

1. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006; 90:262–267. PMID: 16488940.

2. Robin AL, Pollack IP. Argon laser peripheral iridotomies in the treatment of primary angle closure glaucoma: long-term follow-up. Arch Ophthalmol. 1982; 100:919–923. PMID: 7092629.

3. Nolan WP, Foster PJ, Devereux JG, et al. YAG laser iridotomy treatment for primary angle closure in east Asian eyes. Br J Ophthalmol. 2000; 84:1255–1259. PMID: 11049950.

4. Hayashi K, Hayashi H, Nakao F, Hayashi F. Changes in anterior chamber angle width and depth after intraocular lens implantation in eyes with glaucoma. Ophthalmology. 2000; 107:698–703. PMID: 10768331.

5. Melese E, Peterson JR, Feldman RM, et al. Comparing laser peripheral iridotomy to cataract extraction in narrow angle eyes using anterior segment optical coherence tomography. PLoS One. 2016; 11:e0162283. PMID: 27606482.

6. Shams PN, Foster PJ. Clinical outcomes after lens extraction for visually significant cataract in eyes with primary angle closure. J Glaucoma. 2012; 21:545–550. PMID: 21623222.

7. Azuara-Blanco A, Burr J, Ramsay C, et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet. 2016; 388:1389–1397. PMID: 27707497.

8. Husain R, Gazzard G, Aung T, et al. Initial management of acute primary angle closure: a randomized trial comparing phacoemulsification with laser peripheral iridotomy. Ophthalmology. 2012; 119:2274–2281. PMID: 22885123.

9. Foster PJ, Buhrmann R, Quigley HA, Johnson GJ. The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol. 2002; 86:238–242. PMID: 11815354.

10. Moghimi S, Vahedian Z, Fakhraie G, et al. Ocular biometry in the subtypes of angle closure: an anterior segment optical coherence tomography study. Am J Ophthalmol. 2013; 155:664–673. PMID: 23246271.

11. Nonaka A, Kondo T, Kikuchi M, et al. Angle widening and alteration of ciliary process configuration after cataract surgery for primary angle closure. Ophthalmology. 2006; 113:437–441. PMID: 16513457.

12. Hayashi K, Hayashi H, Nakao F, Hayashi F. Effect of cataract surgery on intraocular pressure control in glaucoma patients. J Cataract Refract Surg. 2001; 27:1779–1786. PMID: 11709251.

13. Lai JS, Tham CC, Chan JC. The clinical outcomes of cataract extraction by phacoemulsification in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract: a prospective case series. J Glaucoma. 2006; 15:47–52. PMID: 16378018.

14. Rodrigues MM, Spaeth GL, Sivalingam E, Weinreb S. Histopathology of 150 trabeculectomy specimens in glaucoma. Trans Ophthalmol Soc U K. 1976; 96:245–255. PMID: 1070878.

15. Sihota R, Lakshmaiah NC, Walia KB, et al. The trabecular meshwork in acute and chronic angle closure glaucoma. Indian J Ophthalmol. 2001; 49:255–259. PMID: 12930118.

16. Mishima K, Tomidokoro A, Suramethakul P, et al. Iridotrabecular contact observed using anterior segment three-dimensional OCT in eyes with a shallow peripheral anterior chamber. Invest Ophthalmol Vis Sci. 2013; 54:4628–4635. PMID: 23761081.

17. Kerman BM, Christensen RE, Foos RY. Angle-closure glaucoma: a clinicopathologic correlation. Am J Ophthalmol. 1973; 76:887–895. PMID: 4759849.

18. Sacca SC, Gandolfi S, Bagnis A, et al. The outflow pathway: a tissue with morphological and functional unity. J Cell Physiol. 2016; 231:1876–1893. PMID: 26754581.

19. Meyer MA, Savitt ML, Kopitas E. The effect of phacoemulsification on aqueous outf low facility. Ophthalmology. 1997; 104:1221–1227. PMID: 9261307.

20. Lam DS, Leung DY, Tham CC, et al. Randomized trial of early phacoemulsification versus peripheral iridotomy to prevent intraocular pressure rise after acute primary angle closure. Ophthalmology. 2008; 115:1134–1140. PMID: 18164064.