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Early phacoemulsification in patients with acute primary angle closure.

Sasan Moghimi1, Hesam Hashemian1, Rebecca Chen2

  • 1Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Journal of Current Ophthalmology
|May 31, 2016
PubMed
Summary

Phacoemulsification surgery after acute primary angle closure (APAC) and laser peripheral iridotomy (LPI) effectively prevents long-term intraocular pressure (IOP) rise compared to LPI alone. This early intervention offers a safer, more stable outcome for APAC patients.

Keywords:
Acute primary angle closureGonioscopyIntraocular pressurePhacoemulsificationSynechiae

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Area of Science:

  • Ophthalmology
  • Glaucoma Research
  • Surgical Interventions

Background:

  • Acute primary angle closure (APAC) is a serious ophthalmic condition requiring prompt management.
  • Laser peripheral iridotomy (LPI) is a standard initial treatment for APAC.
  • The long-term efficacy of subsequent interventions like phacoemulsification requires further investigation.

Purpose of the Study:

  • To compare the long-term effectiveness of phacoemulsification in managing APAC after initial treatment with LPI.
  • To evaluate the prevention of intraocular pressure (IOP) rise in APAC patients undergoing early phacoemulsification versus LPI alone.

Main Methods:

  • A prospective, nonrandomized comparative study included 35 APAC patients responding to medical treatment and LPI.
  • Twenty patients with visually significant cataracts underwent phacoemulsification within six weeks (Phaco/LPI group).
  • Fifteen patients with clear lenses were managed with LPI only (LPI Only group), with follow-up for at least one year.

Main Results:

  • The Phaco/LPI group showed significantly lower treatment failure rates (5%) compared to the LPI Only group (40%).
  • Final IOP was significantly lower in the Phaco/LPI group (13.90 ± 2.17 mmHg) versus the LPI Only group (17.8 ± 4.16 mmHg).
  • Patients in the Phaco/LPI group required fewer IOP-lowering medications post-treatment.

Conclusions:

  • Phacoemulsification is a safe and effective procedure for preventing long-term IOP elevation after APAC.
  • Performing phacoemulsification within weeks of an APAC attack improves long-term IOP control.
  • Early phacoemulsification offers superior outcomes compared to LPI alone in managing APAC.