Clinical Results of Phacoemulsification in Eyes With Acute Angle-Closure Glaucoma in the Aspect of Complications

Min Lee Kyung; Soo Lee Hyun; Soo Kim Man

doi:10.3341/jkos.2009.50.1.44

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Kyung, Hyun, and Man: Clinical Results of Phacoemulsification in Eyes With Acute Angle-Closure Glaucoma in the Aspect of Complications

Original Article

J Korean Ophthalmol Soc 2009;50(1):44-50.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.1.44

Clinical Results of Phacoemulsification in Eyes With Acute Angle-Closure Glaucoma in the Aspect of Complications

Min Lee Kyung, M.D, Soo Lee Hyun, M.D, Soo Kim Man, M.D, PhD

Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University, Seoul, Korea

Address reprint requests to Man Soo Kim, MD, PhD Department of Ophthalmology, Kangnam St. mary's Hospital, The Catholic University College of Medicine #505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea Tel: 82-2-590-1523, Fax: 82-2-599-7405, E-mail: mskim@catholic.ac.kr

Received 30 September 2008 Accepted 27 March 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the intraoperative and postoperative complications and outcomes of phacoemulsification of cataract in eyes with prior iriodotomy for acute angle closure glaucoma.

Methods

This retrospective case-control study included 30 eyes which underwent phacoemulsification. All 30 eyes had prior acute angle closure treated by laser iridotomy (ACG group). A second group that had phacoemusification for cataract only served as control (Control group).

Results

The ACG group showed significantly shallow anterior chamber (1.56±0.18 mm) and short axial length (22.32±0.60 mm). At 2 months after surgery, visual acuity was improved in both groups and IOP was significantly decreased in the ACG group. Posterior synechiae, small pupil and zonulysis were more commonly found in the ACG group than the control group. Intraoperative iris trauma and postoperative persistent mydriasis were also more common in the ACG group.

Conclusions

During cataract surgery in eyes with prior iriodotomy for acute angle closure glaucoma, there are many preoperative risk factors such as shallow anterior chamber, zonulysis, and small pupil. These increase the risk of posterior capsule rupture and bullous keratopathy. To reduce the complications and improve the visual acuity, a careful preoperative examination and proper intra- and post-operative management by skillful surgeons are needed.

Keywords: Acute angle closure glaucoma, Cataract, Complication, Phacoemulsification

References

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Figure 1.

Types of cataract in study and control patients. NS=nuclear sclerosis; C=cortical; PSC= posterior subcap sular; Mixed=NS/cortical; PSC/cortical or NS/PSC/Cortical. There are no statistical significant difference between the two groups (P>0.05 in all cases).

Figure 2.

Graphs demonstrating the course of the intraocular pressure (IOP) before and after phacoemulsification. At 1 and 2 months after surgery, intraocular pressure was significantly lowered in the angle-closure group (p=0.018, p=0.011).

Table 1.

Preoperative and postoperative characteristics

	^∗ ACG	Control	p-value
Age (years)	69.07±8.95 (48 to 80)	68.67±8.42 (50 to 81)	0.859
Gender Male	6	9
Female	24	21
IOP (mmHg)	16.53±2.97 (12 to21)	15.53±2.52 (9 to 20)	0.296
† UCVA (logMAR)	0.80±0.11 (0.39 to 2.00)	0.74±0.42 (0.30 to 1.4	40)0.586
‡ BCVA (logMAR)	0.63±0.42 (0.09 to 2.00)	0.60±0.40 (0.49 to 1.4	40)0.763
Medications (number)	1.33±1.09 (0 to 3)	0	0.000
Nucleus opacity score (^§ LOCS III)	3.27±0.98 (2 to 6)	3.27±0.98 (2 to 6)	1.000

^∗ ACG=angle closure glaucoma;

^† UCVA=uncorrected visual acuity;

^‡ BCVA=best corrected visual acuity;

^§ LOCS III=Lens Opacities Classification System III. Independent sample t-test.

Table 2.

Preoperative biometric characteristics

^∗ ACG	Control	P-value
Spherical equivalent (D) -2.09±2.96 (-4.25 to +3.75)	-1.46±3.35 (-4.50 to +3.00)	0.564
Cylindrical refraction (D)1.24±1.28 (plano to 4.25)	1.46±1.46 (plano to 3.25)	0.613
A-scan biomicroscopy
ACD (mm)1.56±0.18 (1.17 to 1.85)	2.56±0.35 (1.89 to 3.32)	0.002
Lens thickness (mm)5.72±0.29 (5.32 to 6.27)	5.26±0.99 (3.52 to 6.26)	0.022
Axial length (mm) 22.32±0.60 (20.9 to 23.9)	23.48±1.03 (21.86 to 25.49)	0.054
† LT to ^‡ AL ratio factor 0.26±0.01 (0.24 to 0.27)	0.23±0.04 (0.15 to 0.26)	0.001
^§ IOL power (D) 22.90±1.53 (20.5 to 26)	20.39±2.25 (16 to 23.5)	0.248
Endothelial cell count (mm²)2268.87±531.39 (1256 to 2932)	2592.40±372.69 (1814 to 3267)	0.004

^∗ ACG=angle closure glaucoma;

^† LT=lens thickness;

^‡ AL=axial length and

^§ IOL=intraocular lens. Independent sample t-test.

Table 3.

Preoperative ocular characteristics

	^* ACG	P-value
Posterior synechia	9 (30.0%)	0.001
Persistent mydriasis	3 (10.0%)	0.076
Small pupil requiring stretching or iris retractor (<5.0 mm)	11 (36.7%)	0.001
Zonulysis	4 (13.3%)	0.038
Lens subluxation	2 (6.7%)	0.150

^∗ ACG=angle closure glaucoma. Pearson’s chi-square test.

Table 4.

Intraoperative observation and complications

Complications	^∗ ACG	Control	P-value
Iris trauma	7 (23.3%)	1 (3.3%)	0.023
Hyphema	4 (13.3%)	0 (0%)	0.038
Unsuccessful ^† CCC	2 (6.7%)	1 (3.3%)	0.554
Posterior capsule rupture	3 (10.0%)	1 (3.3%)	0.301
Without anterior vitrectomy	1 (3.3%)	1 (3.3%)
With anterior vitrectomy	2 (6.7%)	0 (0%)
Radial tear during capsulorhexis or phacoemulsification	3 (10.0%)	0 (0%)	0.076
Dropped nuclear fragment	1 (3.3%)	0 (0%)	0.313

^∗ ACG=angle closure glaucoma;

^† CCC=continuous curvilinear capsulorhexis. Pearson’s chi-square test.

Table 5.

Intraoperative additional procedures

Additional procedures	^∗ ACG	Control	P-value
Synechiolysis	9 (30.0%)	0 (0%)	0.001
Tension ring implantation	2 (6.7%)	0 (0%)	0.150
^† IOL implantation into the sulcus	3 (10.0%)	1 (3.3%)	0.301
IOL scleral fixation	2 (6.7%)	0 (0%)	0.150

^∗ ACG=angle closure glaucoma;

^† IOL=intraocular lens. Pearson’s chi-square test.

Table 6.

Postoperative complications.

Complications	^∗ ACG	Control	P-value
Persistent mydriasis	7 (23.3%)	0 (0%)	0.005
Corneal edema	8 (26.7%)	3 (10.0%)	0.095
Hyphema	4 (13.3%)	0 (0%)	0.038
Vitreous tractional membrane requiring Nd:YAG	2 (6.7%)	0 (0%)	0.150
Increased in intraocular pressure (≥25 mmHg)	2 (6.7%)	0 (0%)	0.150
Bullous keratopathy	1 (3.3%)	0 (0%)	0.313

^∗ ACG=angle closure glaucoma. Pearson’s chi-square test.

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