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Baek, Choi, and Lee: Clinical Outcomes of Early Phacoemulsification after Laser Iridotomy in Acute Angle-closure Glaucoma
Original Article

J Korean Ophthalmol Soc 2016;57(7):1126-1133.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.7.1126

Clinical Outcomes of Early Phacoemulsification after Laser Iridotomy in Acute Angle-closure Glaucoma

Sung Uk Baek, MD1, Dong Chul Choi, MD2, Kyung Wha Lee, MD, PhD2,

1Department of Ophthalmology, Armed Forces DaeGu Hospital, Gyeongsan, Korea

2Department of Ophthalmology, Hallym University College of Medicine, Chuncheon, Korea

Address reprint requests to Kyung Wha Lee, MD, PhD Department of Ophthalmology, Hallym University Sacred Heart Hospital, #22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea Tel: 82-31-380-3834, Fax: 82-31-380-3833 E-mail: kyungwlee@hanmail.net

Received 25 February 2016       Accepted 21 June 2016

Copyright © 2016 Korean Ophthalmological Society

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 long-term change in intraocular pressure (IOP) in eyes undergoing laser iridotomy (LI) and early phacoemulsification after LI in patients with acute angle-closure glaucoma (AACG).

Methods

The retrospective, comparative chart review included patients with AACG, Group A who underwent only LI and Group B who underwent early phacoemulsification within 1 month after LI. Patients were followed up on day 1; week 1; and months 1, 3, 6, and 12 after LI. IOP changes were studied.

Results

This study included a total 99 eyes from 99 patients, 37 in group A and 62 in group B. The mean IOP were not significantly different between the two groups at the initial visit or 1 month later. However, group B showed a consistently lower mean IOP that that of group A at 3, 6, and 12 months (p = 0.003, <0.001, <0.001, respectively). The prevalence of IOP increase to greater than 21 mmHg was 3 (8.11%), 5 (13.51%), and 5 patients (13.51%) in group A and 0, 2 (5.41%), and 1 patients (1.61%) in group B at 3, 6, and 12 months, respectively. Group B showed a significantly lower prevalence of IOP increase (p = 0.050, 0.038, 0.026).

Conclusions

We found that patients treated with early phacoemulsification after LI had better outcomes of well-maintained IOP compared to those undergoing LI alone. For AACG patients with coexisting cataract, early phacoemulsification after LI can be considered as a reasonable treatment to maintain IOP.

Keywords: Acute angle-closure glaucoma, Laser iridotomy, Phacoemulsification

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Figure 1.
Change of mean intraocular pressure for the Group A and B. Group A was 37 patients who underwent only laser iridotomy (LI) and Group B was 62 patients who underwent early phacoemulsification after LI within 1 month. The mean intraocular pressure (IOP) between two groups were not significantly different at initial visit and 1 month. But group B showed consistently lower mean IOP that that of group A for the follow-up at 3, 6, 12 months (p = 0.003, <0.001, <0.001). * p < 0.05 by independent samples t-test.
jkos-57-1126f1.tif
Table 1.
Baseline demographics and presenting clinical feature of all subjects
  A group (N = 32) B group (N = 67) p-value
Mean age (years) 64.05 ± 7.40 69.32 ± 8.15 0.457*
Gender (male:female) 7:30 11:51 0.883†
Laterality (right:left) 24:13 33:29 0.254†
IOP at presentation (mm Hg) 52.70 ± 10.13 45.56 ± 9.56 0.082*
IOP immediately before the intervention 15.89 ± 9.56 14.84 ± 7.24 0.344*
Mean Shaffer gonoiscopy grading 1.70 ± 0.46 1.80 ± 0.40 0.241*
Spherical equivalent (diopters) 0.17 ± 1.12 0.88 ± 1.54 0.016*
Mean LOCS III scores 2.08 ± 1.23 2.58 ± 0.80 0.037*

Values are presented as mean ± SD unless otherwise indicated.

IOP = intraocular pressure; LOCS = Lens Opacification Classification System.

* Independent samples t-test

† Pearson's chi-square test.

Table 2.
Serial changes of mean intraocular pressure for the Group A and B
  A group (IOP, mm Hg) B group (IOP, mm Hg) p-value*
Pre LI 52.70 ± 10.13 45.56 ± 9.56 0.082
1 hour after LI 14.89 ± 6.67 17.68 ± 9.07 0.108
1 day 13.56 ± 7.49 14.76 ± 6.75 0.418
7 days 13.11 ± 3.47 15.01 ± 9.51 0.244
1 month 14.13 ± 3.64 13.35 ± 4.22 0.352
3 months 15.16 ± 3.71 13.03 ± 3.18 0.003
6 months 15.67 ± 2.75 13.27 ± 3.24 <0.001
12 months 16.54 ± 3.47 13.56 ± 3.02 <0.001

Values are presented as mean ± SD unless otherwise indicated.

LI = peripheral laser iridotomy; IOP = intraocular pressure.

* Independent samples t-test.

Table 3.
Prevalence of intraocular pressure rise above 21 mm Hg for the Group A and B
  A group (N = 37) B group (N = 62) p-value*
1 month 3 (8.11) 5 (8.06) 0.709
3 months 3 (8.11) 0 (0) 0.050
6 months 5 (13.51) 2 (3.22) 0.038
12 months 5 (13.51) 1 (1.61) 0.026

Values are presented as n (%)

* Pearson's chi-square test.

Table 4.
Comparison of the clinical outcomes for the Group A and B
  A group (N = 32) B group (N = 67) p-value
Initial BCVA (Snellen) 0.24 ± 0.24 0.31 ± 0.30 0.260*
Final BCVA (Snellen) 0.63 ± 0.26 0.83 ± 0.11 <0.001*
PAS formation 8 (21.62) 0 (0) <0.001†
Development of CACG 11 (29.73) 2 (3.22) 0.001†

Values are presented as mean ± SD or n (%) unless otherwise indicated.

BCVA = best corrected visual acuity; PAS = peripheral anterior synechia; CACG = chronic angle-closure glaucoma.

* Independent samples t-test

† Pearson's chi-square test.

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