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Lens extraction alone may treat selected cases of angle-closure glaucoma
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COPENHAGEN, Denmark — Lens extraction alone may effectively treat selected cases of angle-closure glaucoma, according to a speaker here.
“ACG is mostly age-related and may be caused by increased lens volume in predisposed eyes,” Augusto Azuara-Blanco, MD, said at the European Glaucoma Society meeting.
Augusto Azuara-Blanco
Laser peripheral iridectomy with adjunctive medical therapy is state of the art for treatment, and trabeculectomy is performed in case of failure, but lens extraction may have a role in treating angle-closure glaucoma (ACG), he said.
Studies show that the IOP levels achieved by phaco alone may be comparable to those of phaco-trabeculectomy, but the complication rate is significantly lower, Azuara-Blanco said.
In his practice, he offers the option of phaco alone as a primary intervention or after laser peripheral iridectomy to patients with ACG associated with cataract, taking into account that IOP control and trabecular meshwork outflow improvements are not predictable. In cases of severe ACG and uncontrolled IOP, he performs phaco-trabeculectomy with mitomycin C.
For patients with ACG and a clear lens, he performs laser peripheral iridectomy and considers phaco only if the angle remains closed after lasering and IOP is not well controlled.
Azuara-Blanco is involved in the EAGLE study, evaluating the safety, efficacy, cost-effectiveness and impact on patients’ quality of life of early lens extraction in primary ACG. Study participants are randomized to be treated with phaco and medication or with laser iridotomy and medications.