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Study: Cataract surgery resolves persistent angle closure after iridotomy

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Cataract surgery can relieve angle closure and lower elevated IOP that persists after iridotomy in Asian patients with primary angle-closure glaucoma, according to a study.

Atsushi Nonaka, MD, and colleagues at Kobe City General Hospital in Japan reviewed the records of 70 eyes with primary angle-closure glaucoma that were treated with laser iridotomy and identified 27 eyes (39%) with residual angle-closure. They treated 13 of these eyes with cataract surgery.

Main outcome measures included IOP levels, response to a dark-room prone-position test and morphologic analysis with ultrasound biomicroscopy. All were evaluated before and 3 months after cataract surgery. Eyes that had an IOP of at least 20 mm Hg or that had glaucomatous visual field defects before undergoing iridotomy had a significantly higher incidence of residual angle closure after iridotomy than eyes without a higher IOP or glaucomatous visual field defect.

“In this series of patients,” the study authors said in the June issue of Ophthalmology, “residual angle closure was common after laser iridotomy in eyes with primary angle closure, resulting in poor IOP control, especially in the advanced stages with elevated IOP or glaucomatous optic neuropathy. Cataract surgery subsequent to laser iridotomy was also effective for complete resolution of residual angle closure, which was due primarily to plateau iris, with concomitant lowering of IOP.”

In all of the eyes with residual angle closure after iridotomy, the response to the prone-position test became negative after cataract surgery, with significant lowering of IOP (P < .01).

Among the limitations of the study were that it was not prospective, the authors acknowledged, nor was it optimal in that the researchers would have preferred to use data from only one eye of each patient.

“Finally,” the authors said, “the study population was Asian (predominantly Japanese), and it is not known if the results could be applied to other racial groups.”