The clinical outcomes of cataract extraction by phacoemulsification in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract: a prospective case series.
OBJECTIVE
To evaluate the clinical outcomes of minimally invasive cataract extraction by phacoemulsification, with primary intraocular lens implantation, in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract.


METHODS
Consecutive primary angle-closure glaucoma patients with co-existing visually significant cataract were invited to participate in this prospective study. After obtaining informed consent, cataract extraction by phacoemulsification through a clear corneal incision was performed under topical anesthesia. Foldable intraocular lenses were implanted in the same setting. These patients were then followed up for a minimum of 1 year. Outcome measures included intraocular pressure (IOP), requirement for glaucoma drugs, and visual acuity.


RESULTS
Twenty-one primary angle-closure glaucoma eyes of 21 patients were recruited. Mean age (+/- SD) was 73.7 +/- 8.1 years (range, 60-87 years). There were 12 female patients and 9 male patients, with 13 right eyes and 8 left eyes. Nine eyes (42.9%) had history of acute primary angle closure. Mean follow-up duration was 20.7 +/- 3.6 months (range, 13-26 months). Intraocular pressure was decreased from a mean preoperative level of 19.7 +/- 6.1 mm Hg (range, 11 mm Hg-40 mm Hg) to 15.5 +/- 3.9 mm Hg (range, 9 mm Hg-26 mm Hg) at final follow-up (P = 0.022) (paired t test). The number of glaucoma eye drops required was decreased from a mean preoperative level of 1.91 +/- 0.77 (range, 1-3) to 0.52 +/- 0.87 (range, 0-3) at final follow-up (P < 0.001) (paired t test). In 10 eyes (47.6%), visual acuity improved significantly after surgery. In 9 eyes (42.9%), visual acuity remained the same. In 2 eyes (9.5%), visual acuity deteriorated significantly after surgery. Mean cup-to-disc ratio was 0.6 +/- 0.2 (range, 0.3-0.9) preoperatively, and 0.7 +/- 0.2 (range, 0.3-0.9) postoperatively (P = 0.047) (paired t test).


CONCLUSIONS
In primary angle-closure glaucoma patients with co-existing cataract, cataract extraction alone (by phacoemulsification) can significantly reduce both intraocular pressure and the requirement for glaucoma drugs.
Lai
Jimmy S M
JS
Department of Ophthalmology, United Christian Hospital, Kowloon, Hong Kong SAR, Peoples' Republic of China. laism@ha.org.hk
Tham
Clement C Y
CC
Chan
Jonathan C H
JC
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage; D002386:Cataract / Q000150:complications*; D004363:Drug Utilization; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D018918:Phacoemulsification / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity
D000959:Antihypertensive Agents