Lens extraction for uncontrolled angle-closure glaucoma: long-term follow-up

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Outcomes

Background:

• Angle-closure glaucoma poses significant challenges to intraocular pressure (IOP) management.
• Subacute or chronic angle-closure glaucoma often requires complex surgical interventions.
• Evaluating novel treatment strategies is crucial for improving patient outcomes.

Purpose of the Study:

• To assess the long-term efficacy of lens extraction in managing glaucoma in patients with subacute or chronic angle-closure glaucoma.
• To compare the outcomes of lens extraction with those of traditional filtering procedures.

Main Methods:

• Retrospective analysis of 18 patients undergoing extracapsular lens extraction with intraocular lens implantation (Group 1).
• Comparison with 19 patients who underwent filtering procedures for chronic angle-closure glaucoma (Group 2).
• Evaluation metrics included visual fields, diurnal IOP, gonioscopy, and medication use.

Main Results:

• Glaucoma control was achieved in 68% of patients in both groups.
• Lens extraction (Group 1) resulted in a mean IOP reduction and required fewer additional surgeries (27%) compared to filtering procedures (Group 2, 80%).
• Visual acuity outcomes were significantly better in the lens extraction group (91% maintained or improved) versus the filtering group (52% unchanged/better, 48% worse).

Conclusions:

• Lens extraction offers comparable glaucoma control to filtering surgery but with fewer complications and better visual preservation.
• Initiating treatment with lens extraction, with potential for future trabeculectomy, appears more advantageous than trabeculectomy followed by optional cataract surgery.
• This suggests a shift in preferred surgical strategy for angle-closure glaucoma management.