Surgical management of closed angle glaucoma: our experience

Area of Science:

• Ophthalmology
• Surgical Treatment
• Glaucoma Management

Background:

• Closed-angle glaucoma presents challenges in intraocular pressure (IOP) control, often requiring maximal medical or laser therapy.
• Lens opacities can coexist with closed-angle glaucoma, complicating management and potentially necessitating intervention.
• Previous YAG laser iridotomy may not achieve sustained IOP control in all patients.

Purpose of the Study:

• To evaluate the efficacy of extracapsular lens extraction and posterior chamber intraocular lens implantation in treating closed-angle glaucoma.
• To assess the impact of this surgical procedure on intraocular pressure and the need for anti-glaucoma medication.
• To analyze outcomes in patients with varying degrees of IOP control prior to surgery.

Main Methods:

• Retrospective analysis of 34 eyes from 34 patients with closed-angle glaucoma undergoing extracapsular lens extraction and intraocular lens implantation.
• Patients were categorized based on pre-operative IOP control and medication requirements.
• Follow-up duration extended up to 40 months, with mean follow-up of 20.3 months.

Main Results:

• Significant reduction in mean IOP observed in eyes with high pre-operative IOP (from 29.7 mmHg to 15.1 mmHg, p < 0.005).
• Mean IOP reduction of 3.1 mmHg (p < 0.005) in eyes with pre-operative IOP already under control.
• Post-operative reduction in the need for anti-glaucoma medication, with 28 eyes not requiring medication after surgery compared to 11 pre-operatively.

Conclusions:

• Extracapsular lens extraction and intraocular lens implantation is a safe and effective surgical treatment for closed-angle glaucoma.
• The procedure leads to satisfactory intraocular pressure control and reduces reliance on medical therapy.
• No eyes required filtering procedures post-operatively, indicating successful IOP management through lens extraction.