Early lens extraction improves outcomes in primary angle-closure glaucoma
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Patients with primary angle-closure glaucoma were more likely to maintain drop-free IOP control with early lens extraction rather than laser peripheral iridotomy, according to a study.
In his presentation at the virtual Association for Research in Vision and Ophthalmology meeting, David S. Friedman, MD, PhD, MPH, discussed results from the pragmatic randomized controlled EAGLE trial that compared early lens extraction with laser peripheral iridotomy (LPI) in patients with primary angle-closure glaucoma (PACG) or primary angle closure (PAC) with high IOP. Researchers also assessed baseline parameters associated with better long-term IOP control.
Study patients did not have cataract and had newly diagnosed PAC with IOP of at least 30 mm Hg or PACG. Good responders were defined as those with IOP less than 21 mm Hg at 36-month follow-up with no additional surgery. “Great responders” also required no medications.
Overall, 369 patients completed the 36-month follow-up visit, including 182 who underwent lens extraction and 187 who underwent LPI.
Among patients who underwent lens extraction, 89.6% met the criteria for good response at 36 months compared with 66.8% in the LPI group. In addition, 63.9% of patients in the lens extraction group met the criteria for great response compared with 17.7% in the LPI group.
In a multivariate analysis, Friedman and colleagues determined that patients who were randomly assigned to LPI, those with non-Chinese ethnicity, those who previously used glaucoma drops and those who had higher baseline IOP were less likely to maintain long-term good IOP control over 36 months.
“Nearly 90% of those patients who underwent clear lens extraction are controlled without further surgery at 3 years, and nearly two-thirds required no medications,” Friedman said. “Those already requiring medications and with primary angle-closure glaucoma at the beginning are less likely to be free of medications over the long term. Those undergoing laser iridotomy are unlikely to be medication-free, and many will require additional surgery.”
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Friedman DS, et al. Predictors of long-term intraocular pressure control after clear lens extraction in primary angle closure glaucoma: results from the EAGLE. Presented at: Association for Research in Vision and Ophthalmology annual meeting; May 1-7, 2021 (virtual meeting).
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