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Speaker reviews surgical treatment protocols for angle-closure glaucoma
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NEW YORK — Phacoemulsification with IOL implantation is a viable approach in cases of acute angle-closure glaucoma, a speaker said here.
At OSN New York 2012, Garry P. Condon, MD, presented surgical pearls and an overview of literature on evolving treatment protocols for cataract removal in cases of angle-closure glaucoma.
Condon cited a study published in Ophthalmology in 2009 by Tham and colleagues comparing phacoemulsification alone vs. phacotrabeculectomy for chronic angle-closure glaucoma. Results showed that the phacotrabeculectomy group required 1.25 fewer medications postoperatively than the phacoemulsification alone group. However, there were more complications and no difference in visual field progression with phacotrabeculectomy, Condon said.
Condon cited several studies supporting early small-incision phacoemulsification for acute angle-closure glaucoma. In 2007, Lam and colleagues reported that 3% of eyes that underwent phacoemulsification and 29% of eyes that had laser iridectomy or iridoplasty had recalcitrant IOP elevation. However, endothelial cell loss was significant in 14% of phaco eyes and 13% of laser eyes.
Indications for phacoemulsification in cases of angle-closure glaucoma include failed or inadequate initial treatment, 180° of angle closure despite laser treatment and chronic symptomatic mydriasis, Condon said.
Surgical challenges in phaco for acute angle-closure glaucoma are shallow anterior chamber and difficulty maintaining the space and controlling the capsulorrhexis, Condon said.
Postoperative concerns include high corticosteroid and NSAID use, early postoperative IOP spikes and a potential risk of malignant glaucoma.
Condon noted that lensectomy is not suggested as first-line therapy. Early lensectomy is most effective for residual closure, and phacoemulsification is currently safer than trabeculectomy. A clear corneal incision keeps trabeculectomy in the picture as a viable option, he said.
Disclosure: Condon is a consultant and serves on the speakers bureau for Alcon, Allergan and MST.
OSN New York 2013 will be held September 6-8 at the Waldorf-Astoria in New York City. Learn more at www.osnny.com.