title: Ultrasound biomicroscopic assessment of angle parameters in patients with primary angle closure glaucoma undergoing phacoemulsification.
abstract: OBJECTIVE
  To evaluate the effect of phacoemulsification and foldable intraocular lens (IOL) implantation on biometric determinants of the anterior chamber angle in primary angle closure glaucoma (PACG) using ultrasound biomicroscopy (UBM).
  
  
  METHODS
  Forty-six eyes of 46 patients with chronic PACG and cataract having a patent laser iridotomy were included in this prospective, interventional case series. Angle parameters were measured using UBM before surgery and 3 months after phacoemulsification with IOL implantation. Intraocular pressure (IOP) was measured by applanation tonometer and records of glaucoma medication administered were maintained. Main outcome measures were IOP, central anterior chamber depth (ACD), trabecular iris angle (TIA), and angle opening distance at 250 and 500 µm from scleral spur (AOD250 and AOD500).
  
  
  RESULTS
  The mean age of study participants was 56.5 ± 9.9 years (range 44-75). The preoperative mean IOP was 25.0 ± 5.4 mmHg on maximum antiglaucoma medication, which was reduced to 15.8 ± 3.8 mmHg (p = 0.0001) at 3 months. Number of antiglaucoma medications also decreased from 2.4 ± 1.1 to 0.4 ± 1.1 (p = 0.0001). There was a significant widening of the anterior chamber angle with the TIA increasing significantly after phacoemulsification (p<0.001) with an associated increase in AOD250, AOD500, and ACD (p<0.001).
  
  
  CONCLUSIONS
  Phacoemulsification in eyes with PACG results in significant widening of the anterior chamber angle. This results in better IOP control after surgery and decreases the need for glaucoma medications. These findings are of clinical significance in obviating the need for simultaneous filtering surgery in eyes with PACG undergoing phacoemulsification cataract surgery.
authors.affiliation: Glaucoma Facility, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. tanujdada@gmail.com
authors.forename: Tanuj
authors.initials: T
authors.lastname: Dada
authors.forename: Shalini
authors.initials: S
authors.lastname: Mohan
authors.forename: Shveta Jindal
authors.initials: SJ
authors.lastname: Bali
authors.forename: Shibal
authors.initials: S
authors.lastname: Bhartiya
authors.forename: Amit
authors.initials: A
authors.lastname: Sobti
authors.forename: Anita
authors.initials: A
authors.lastname: Panda
mesh_terms: D000328:Adult; D000368:Aged; D000869:Anterior Eye Segment / Q000000981:diagnostic imaging*; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001699:Biometry; D002386:Cataract / Q000150:complications; D002908:Chronic Disease; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D019654:Lens Implantation, Intraocular; D008297:Male; D033401:Microscopy, Acoustic; D008875:Middle Aged; D018918:Phacoemulsification; D011446:Prospective Studies; D014065:Tonometry, Ocular
chemical_list: D000959:Antihypertensive Agents