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Early phaco lowers IOP more than iridotomy in some glaucoma patients

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NEW ORLEANS — Performing early phaco on patients with acute primary angle-closure glaucoma unresponsive to medication resulted in lower IOP than with laser peripheral iridotomy, a study found.

The results, from a randomized trial of the two techniques, could be due to a lower response threshold for phaco in post-acute primary angle-closure glaucoma patients with cataract, Dexter Yu-lung Leung, MBChB, said at a free paper session at the annual American Academy of Ophthalmology meeting here.

"Further studies will be required to determine the optimal timing of phaco, which would be to reduce complications," Dr. Leung said.

Dr. Leung and colleagues found that at 18 months, the 3% rate of IOP rise for the phaco group was significantly lower than the laser peripheral iridotomy group, at 46.7% (P < .0001). An IOP of more than 55 mm Hg is also an added risk factor for further IOP rise, Dr. Leung said.

The study looked at 62 eyes of 62 subjects who had acute primary open angle-closure glaucoma. Glaucoma was aborted by topical and or systemic anti-glaucoma treatment, Dr. Leung said. Phaco, with IOL implantation of AcrySof (Alcon), was performed by a single surgeon under topical or peribulbar anesthesia, with a temporal 3.5 mm clear corneal incision, he said. Laser peripheral iridotomy was performed under topical anesthesia with a sequential Argon YAG technique.