Primary lens extraction for glaucoma management: A review article

Area of Science:

• Ophthalmology
• Glaucoma Management
• Surgical Innovation

Background:

• Primary lens extraction is increasingly recognized as a surgical alternative for glaucoma management.
• Advances in phacoemulsification and intraocular lenses enhance safety and visual recovery.
• This approach offers potential benefits like reduced intraocular pressure (IOP), deepened anterior chamber, and widened filtration angles.

Purpose of the Study:

• To evaluate the efficacy of primary lens extraction as a standalone surgical treatment for different types of glaucoma.
• To compare the intraocular pressure (IOP)-lowering effects in primary open-angle glaucoma (POAG) versus primary angle closure glaucoma (PACG).
• To explore the role of lens extraction in managing acute and chronic PACG and its comparison with traditional glaucoma surgeries.

Main Methods:

• Review of current literature and clinical acceptance of primary lens extraction for glaucoma.
• Analysis of IOP reduction trends in POAG and PACG patients undergoing lens extraction.
• Comparison of outcomes between lens extraction and other glaucoma surgical interventions.

Main Results:

• Lens extraction provides a mild, less predictable IOP reduction in POAG, which may not be sustained.
• Lens extraction consistently achieves greater IOP reduction in PACG compared to POAG.
• In acute PACG, lens extraction reduces recurrence risk, deepens the anterior chamber, and widens the angle, mitigating risks of synechiae and chronic PACG.

Conclusions:

• Primary lens extraction is a potentially preferable option over incisional surgery for mild to moderate PACG with appositional angle closure.
• The decision for primary lens extraction requires individualization, considering patient factors, surgeon expertise, glaucoma status, and lens choice.
• While beneficial for PACG, the IOP-lowering effect in POAG may be insufficient for adequate control.