Lens Extraction in Primary Angle-Closure Glaucoma Management
Lens Extraction in Primary Angle-Closure Glaucoma Management
The argument for lens extraction in PACG is justified by the coexistence of cataract. Postoperative visits, ocular surface discomfort and inflammation are less frequent after phacoemulsification than after glaucoma filtration surgery. Unsurprisingly, numerous studies have demonstrated greater patient satisfaction following phacoemulsification surgery. Coupled with reduced expense, an argument develops for a procedure with shorter recovery, faster visual rehabilitation, less onerous follow-up and reduced risk.
In cases of PACG without cataract, clear lens phacoemulsification (CLP) is controversial. Phacoemulsification is not without its risks: as a guide, the UK national cataract database of 55 297 cataract operations revealed an overall posterior capsule rupture rate of 1.92%, and current estimates of endophthalmitis range between 0.03 and 0.74%. Furthermore, patient dissatisfaction after phacoemulsification may vary depending on the patient's refractive status. The probability of the visual acuity being inferior after surgery than that before surgery will be higher if the preoperative visual acuity was -0.1 logMAR as opposed to 0.5 logMAR, for example (other factors such as contrast sensitivity may improve, however). Factors that may favor CLP for PACG include the presence of hyperopia and contact lens intolerance. Opponents of CLP cite that patients are subjected to unnecessary risk in the absence of a cataract affecting visual function.
A major clinical trial (Effectiveness in Angle Closure of Lens Extraction) is ongoing, which will assess the cost–effectiveness of early lens extraction on quality of life, vision and stability of the disease when compared with standard treatment in patients with PACG without cataract.
Cataract Surgery Versus Clear Lens Phacoemulsification
The argument for lens extraction in PACG is justified by the coexistence of cataract. Postoperative visits, ocular surface discomfort and inflammation are less frequent after phacoemulsification than after glaucoma filtration surgery. Unsurprisingly, numerous studies have demonstrated greater patient satisfaction following phacoemulsification surgery. Coupled with reduced expense, an argument develops for a procedure with shorter recovery, faster visual rehabilitation, less onerous follow-up and reduced risk.
In cases of PACG without cataract, clear lens phacoemulsification (CLP) is controversial. Phacoemulsification is not without its risks: as a guide, the UK national cataract database of 55 297 cataract operations revealed an overall posterior capsule rupture rate of 1.92%, and current estimates of endophthalmitis range between 0.03 and 0.74%. Furthermore, patient dissatisfaction after phacoemulsification may vary depending on the patient's refractive status. The probability of the visual acuity being inferior after surgery than that before surgery will be higher if the preoperative visual acuity was -0.1 logMAR as opposed to 0.5 logMAR, for example (other factors such as contrast sensitivity may improve, however). Factors that may favor CLP for PACG include the presence of hyperopia and contact lens intolerance. Opponents of CLP cite that patients are subjected to unnecessary risk in the absence of a cataract affecting visual function.
A major clinical trial (Effectiveness in Angle Closure of Lens Extraction) is ongoing, which will assess the cost–effectiveness of early lens extraction on quality of life, vision and stability of the disease when compared with standard treatment in patients with PACG without cataract.
