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Primary lens extraction for glaucoma management: A review article.

¹Tanta University, Egypt.

Saudi Journal of Ophthalmology : Official Journal of the Saudi Ophthalmological Society

|August 21, 2013

Summary

Primary lens extraction is a viable surgical option for glaucoma, particularly effective in primary angle closure glaucoma (PACG) for reducing intraocular pressure (IOP) and preventing attacks. Its effectiveness in primary open-angle glaucoma (POAG) is less predictable.

Keywords:

Angle closure glaucoma Intraocular pressure Open-angle glaucoma Primary lens extraction Surgical management

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Published on: May 5, 2022

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.