Primary phacoemulsification and intraocular lens implantation for acute angle-closure glaucoma.
OBJECTIVE
To evaluate the safety and efficacy of primary phacoemulsification and intraocular lens implantation (PPI) for acute angle-closure glaucoma (ACG).


METHODS
Prospective, nonrandomized comparative trial.


METHODS
Forty-three eyes of 43 patients with acute ACG and uncontrolled intraocular pressure (IOP) were treated by PPI. Thirty-two eyes of 32 patients treated by conventional surgical iridectomy (CSI) constituted the control group.


METHODS
Postoperative visual acuity, IOP, number of antiglaucoma medications, complications, and secondary surgical interventions, if any, required for IOP control.


RESULTS
Glaucoma control was achieved in 31 eyes (72%) in the PPI group and in 11 (35%) in the CSI group (P = 0.01). Mean preoperative IOP was 40.5 +/- 7.6 mmHg (standard deviation) and 39.7 +/- 7.8 mmHg, respectively (P = 0.46). Mean postoperative IOP was 17.8 +/- 3.4 mmHg (PPI group) and 20.1 +/- 4.2 mmHg (CSI group) after a mean follow-up of 10.2 +/- 3.4 months (P = 0.03). Postoperatively, the mean number of ocular hypotensive medications was 0.18 +/- 0.45 (PPI group) and 0.45 +/- 0.62 (CSI group) (P = 0.0001). Relative increase in postoperative best-corrected visual acuity (logarithm of the minimum angle of resolution) was 0.52 +/- 0.29 (PPI group) and 0.19 +/- 0.21 (CSI group), respectively (P = 0.0001). Additional surgery was necessary in 5 eyes (11.5%) in the PPI group and in 20 eyes (63%) in the CSI group (P = 0.01). Intraoperative and postoperative complications were few and manageable.


CONCLUSIONS
CSI in patients with acute ACG was effective in reducing IOP initially but was associated with multiple surgical reinterventions. Conversely, primary PPI turned out to be safe and effective in reducing IOP and improving visual acuity. These results affirm that lens extraction may be considered the better procedure in uncontrolled ACG when faced with options of CSI or PPI.
Jacobi
Philipp C
PC
University of Cologne, Department of Ophthalmology, Cologne, Germany.
Dietlein
Thomas S
TS
Lüke
Christoph
C
Engels
Bert
B
Krieglstein
Günter K
GK
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D007498:Iris / Q000601:surgery; D053685:Laser Therapy; D019654:Lens Implantation, Intraocular / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D011446:Prospective Studies; D012449:Safety; D016896:Treatment Outcome; D014792:Visual Acuity