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Progressive peripheral anterior synechiae may warrant earlier cataract extraction
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Six months after phacoemulsification, mean intraocular pressure was reduced 20% in eyes suspected for primary angle-closure and in those with primary angle closure with no medical therapy, according to researchers in the Journal of Cataract and Refractive Surgery.
Twelve studies were included in the systematic review, and patients who were on no medical treatment within 6 months before or 6 months after phacoemulsification were recruited.
The study included 85 patients (85 eyes: 52 primary angle-closure suspect, 33 primary angle closure), with patient age ranging from 53 to 86 years. There were 21 men and 64 women.
Overall, the IOP dropped by 19.9% from the preoperative mean, and the reduction was similar between the primary angle-closure suspect (PACS) and primary angle closure (PAC) groups.
An increase of more than 1.0 mm Hg occurred in 12 eyes, according to researchers.
The majority of patients (74%) had a reduction that ranged from 1.0 mm Hg to 10.0 mm Hg, and nearly one-fourth (22.4%) experienced an IOP decrease of more than 6.0 mm Hg.
As the patients were not on IOP-lowering treatment within a period of 6 months before and after surgery, researchers attribute the IOP response to the effect of cataract removal.
“The IOP response after cataract surgery is somewhat unpredictable because it is largely dependent on a multitude of factors, including that a higher preoperative IOP is reportedly the most significant factor associated with a greater IOP drop after cataract removal,” the researchers wrote.
Phacoemulsification is not as successful for IOP reduction in patients with more than 180 degrees of peripheral anterior synechiae (PAS) as it is in those with less PAS, the researchers continued.
The 20% reduction estimate might provide insight into the anticipated IOP drop after phacoemulsification in PAC and PACS patients, according to researchers.
The “development of progressive PAS in an eye with coexisting cataract might warrant earlier cataract extraction for a more favorable postoperative IOP course,” the researchers wrote. – by Abigail Sutton
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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Lisa M. Young, OD, FAAO
While the gold standard of therapy for primary angle closure and primary angle closure suspect is laser peripheral iridotomy, Atalay and colleagues have demonstrated further proof that early lens extraction is a reasonable alternative as first-line treatment for a more favorable postoperative IOP course.
They found an almost 20% reduction in IOP following cataract extraction, with greater success in patients with higher preoperative IOP readings and less than 180 degrees of peripheral anterior synechia (PAS).
When evaluating patients with narrow anterior chamber angles and coexisting cataracts, it is important to take into consideration not only the IOP but also the extent of PAS in order to determine the optimal course of treatment … as progressive changes in PAS may warrant the consideration for phacoemulsification prior to cataract-related visual complaints.
While the ultimate goal is pressure management, the path of least resistance is the name of the game.
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