Lens extraction versus laser peripheral iridotomy for acute primary angle closure

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Interventions

Background:

• Acute primary angle closure (APAC) is an ophthalmic emergency with high visual morbidity risk.
• Laser peripheral iridotomy (LPI) is the current standard but doesn’t eliminate long-term risks.
• Lens extraction is being explored for angle closure, but its efficacy in APAC requires evaluation.

Purpose of the Study:

• To compare the effectiveness of lens extraction versus LPI for treating APAC.
• To inform clinical decision-making regarding the primary treatment for APAC.

Main Methods:

• Systematic search of multiple electronic databases for randomized controlled trials (RCTs).
• Included RCTs compared lens extraction with LPI in adult participants with APAC.
• Assessed evidence certainty using the GRADE approach.

Main Results:

• Two studies (99 participants) compared phacoemulsification (a type of lens extraction) with LPI.
• Phacoemulsification showed potential for better intraocular pressure (IOP) control and reduced need for further IOP-lowering surgery.
• Evidence for other outcomes like recurrent APAC, visual acuity, and peripheral anterior synechiae was of very low to low certainty.

Conclusions:

• Low certainty evidence suggests lens extraction may offer superior IOP control compared to LPI in APAC.
• Evidence for other clinical outcomes remains unclear.
• High-quality, long-term studies are needed to assess glaucomatous damage, visual fields, and quality of life.