Clinical outcomes of clear lens extraction in eyes with primary angle closure.
OBJECTIVE
To evaluate the effect of clear lens extraction (CLE) on intraocular pressure (IOP) and the anterior chamber angle in primary angle closure after laser peripheral iridotomy (LPI).


METHODS
Tertiary eyecare center at a university hospital, New Delhi, India.


METHODS
Prospective case series.


METHODS
The study included eyes with primary angle closure and an IOP over 25.0 mm Hg more than 8 weeks after LPI. All eyes had CLE by phacoemulsification. Absolute success was defined as an IOP less than 18.0 mm Hg without medications at 12 months.


RESULTS
In 44 eyes (24 women, 20 men; mean age 57.2 years ± 4.2 [SD]), the mean preoperative IOP of 27.1 ± 1.55 mm Hg decreased to 13.2 ± 1.12 mm Hg at 12 months (P < .0001). The angle opening distance at 500 μm increased from baseline values at 0 degrees (from 0.104 ± 0.015 mm to 0.31 ± 0.013 mm) and 180 degrees (from 0.202 ± 0.008 mm to 0.412 ± 0.012 mm). The trabecular iris angle also increased at 0 degrees (from 9.3 ± 3.2 degrees to 32.7 ± 5.6 degrees) and 180 degrees (from 9.12 ± 3.2 degrees to 31.7 ± 5.6 degrees) (all P < .0001). In multivariate analysis, the preoperative IOP was the strongest determinant of IOP change (R(2) = 0.69, P < .0001). Absolute success was achieved in 38 eyes (86.3%).


CONCLUSIONS
Clear lens extraction led to a significant reduction in IOP, a widening of the anterior chamber angle, and a reduced need for ocular hypotensive medications in eyes with primary angle closure and persistently raised IOP after LPI.


BACKGROUND
No author has a financial or proprietary interest in any material or method mentioned.
From the Glaucoma, Cataract and Refractive Surgery Services (Dada, Rathi, Angmo, Agarwal, Vanathi, Khokar), Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; the Cornea, Cataract and Refractive Surgery Services (Vajpayee), Vision Eye Institute, Royal Victorian Eye and Ear Hospital, North West Academic Centre, University of Melbourne, Melbourne, Australia. Electronic address: tanujdada@gmail.com.
Tanuj
T
Dada
From the Glaucoma, Cataract and Refractive Surgery Services (Dada, Rathi, Angmo, Agarwal, Vanathi, Khokar), Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; the Cornea, Cataract and Refractive Surgery Services (Vajpayee), Vision Eye Institute, Royal Victorian Eye and Ear Hospital, North West Academic Centre, University of Melbourne, Melbourne, Australia.
Anubha
A
Rathi
From the Glaucoma, Cataract and Refractive Surgery Services (Dada, Rathi, Angmo, Agarwal, Vanathi, Khokar), Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; the Cornea, Cataract and Refractive Surgery Services (Vajpayee), Vision Eye Institute, Royal Victorian Eye and Ear Hospital, North West Academic Centre, University of Melbourne, Melbourne, Australia.
Dewang
D
Angmo
From the Glaucoma, Cataract and Refractive Surgery Services (Dada, Rathi, Angmo, Agarwal, Vanathi, Khokar), Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; the Cornea, Cataract and Refractive Surgery Services (Vajpayee), Vision Eye Institute, Royal Victorian Eye and Ear Hospital, North West Academic Centre, University of Melbourne, Melbourne, Australia.
Tushar
T
Agarwal
From the Glaucoma, Cataract and Refractive Surgery Services (Dada, Rathi, Angmo, Agarwal, Vanathi, Khokar), Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; the Cornea, Cataract and Refractive Surgery Services (Vajpayee), Vision Eye Institute, Royal Victorian Eye and Ear Hospital, North West Academic Centre, University of Melbourne, Melbourne, Australia.
Murugesan
M
Vanathi
From the Glaucoma, Cataract and Refractive Surgery Services (Dada, Rathi, Angmo, Agarwal, Vanathi, Khokar), Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; the Cornea, Cataract and Refractive Surgery Services (Vajpayee), Vision Eye Institute, Royal Victorian Eye and Ear Hospital, North West Academic Centre, University of Melbourne, Melbourne, Australia.
Sudarshan K
SK
Khokhar
From the Glaucoma, Cataract and Refractive Surgery Services (Dada, Rathi, Angmo, Agarwal, Vanathi, Khokar), Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; the Cornea, Cataract and Refractive Surgery Services (Vajpayee), Vision Eye Institute, Royal Victorian Eye and Ear Hospital, North West Academic Centre, University of Melbourne, Melbourne, Australia.
Rasik B
RB
Vajpayee
D000867:Anterior Chamber / Q000473:pathology; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000503:physiopathology / Q000601:surgery*; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D032801:Iridectomy; D007498:Iris / Q000601:surgery*; D007908:Lens, Crystalline / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D011446:Prospective Studies; D041623:Tomography, Optical Coherence; D014065:Tonometry, Ocular; D014792:Visual Acuity / Q000502:physiology