Phacoemulsification reduces IOP in eyes with primary angle closure glaucoma

Eur J Ophthalmol. 2011;21(5):559-565.

Phacoemulsification opened the peripheral iridocorneal angle and reduced IOP in eyes with primary angle closure glaucoma, a study found.

"We ... believe that in eyes without advanced field and optic nerve head damage with associated cataract, phacoemulsification alone may be sufficient to combat the [primary angle closure glaucoma], since the lens is the single most important contributing factor to the angle closure process," the study authors said. "Phacoemulsification achieves this by relieving any element of residual pupillary block, and also causing a significant posterior shift of the iris and opening the anterior chamber angle."

The prospective study included 46 eyes of 46 patients with chronic primary angle closure glaucoma and cataract. Mean patient age was 56.5 years.

Investigators evaluated best corrected visual acuity, refraction, keratometry, A-scan biometry, slit lamp biometry, Goldmann applanation tonometry, fundus examination, gonioscopy and ultrasound biomicroscopy.

All patients underwent patent iridotomy, phacoemulsification and IOL implantation.

Primary outcome measures were IOP, central anterior chamber depth, trabecular iris angle, and angle opening at 250 µm and 500 µm from the scleral spur.

The mean preoperative IOP was 25 mm Hg. The mean number of glaucoma medications was 2.4.

Study results showed that mean postoperative IOP was 17.1 mm Hg at 1 week, 16.5 mm Hg at 4 weeks, 16.2 mm Hg at 6 weeks and 15.8 mm Hg at 12 weeks. IOP reduction was statistically significant at all follow-up points ( P < .0001).

Number of glaucoma medications was significantly reduced to 0.41 (P < .0001), the authors said.