Phacoemulsification versus Laser Peripheral Iridotomy in Early Treatment of Acute Primary Angle-Closure Glaucoma

Chang Hoon Lee; In Cheon You; You Ra Kim

doi:10.3341/jkos.2016.57.2.290

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Lee, You, and Kim: Phacoemulsification versus Laser Peripheral Iridotomy in Early Treatment of Acute Primary Angle-Closure Glaucoma

Original Article

J Korean Ophthalmol Soc 2016;57(2):290-295.

Published online: 7 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.2.290

Phacoemulsification versus Laser Peripheral Iridotomy in Early Treatment of Acute Primary Angle-Closure Glaucoma

Chang Hoon Lee, MD, In Cheon You, MD, PhD, You Ra Kim, MD

Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea

Address reprint requests to You Ra Kim, MD Department of Ophthalmology, Chonbuk National University Hospital, #20 Geonji-ro Deokjin-gu, Jeonju 54907, Korea Tel: 82-63-250-1960, Fax: 82-63-250-1878 E-mail: eggyoura@hanmail.net

Received 19 June 2015 Revised 31 October 2015 Accepted 30 December 2015

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

We compared the outcomes of laser iridotomy and primary phacoemulsification when treating acute angle-closure glaucoma.

Methods

This study was conducted with 61 patients diagnosed with acute angle closure glaucoma from January, 2005 to January, 2015. The patients received either laser iridotomy or primary phacoemulsification. The age and gender of each patient, differences of intraocular pressure (IOP) before and after treatment, visual acuity, need for IOP lowering agents and complications were analyzed retrospectively at 1-day, 1-month, 6-month and 12-month after the treatment. Patients who received laser iridotomy with phacoemulsification or trabeculectomy were excluded from this study. Additionally, we included only cases in which treatments were given within 3 days after the onset of symptom.

Results

Among the 61 patients, 45 patients received laser iridotomy and 16 patients received primary phacoemulsification. One day after the treatment the laser iridotomy group showed better outcome in their visual acuity (log MAR 0.62 ± 0.51; p = 0.048). At 6-month postoperatively, the primary phacoemulsification group showed better visual acuity (log MAR 0.07 ± 0.15; p = 0.013). However, at 12-month postoperatively, the visual acuities were not significantly different between the 2 groups. Regarding IOP, at postoperative 1-month, the group of primary phacoemulsification shows significantly lower IOP (9.5 ± 1.3 mm Hg), compared with the group of laser iridotomy. A significant difference was observed in the number of IOP lowering agents that patients at 12 month after the treatment. There were no severe complications in either group.

Conclusions

Following the initial treatment of acute angle-closure glaucoma, the primary phacoemulsification showed no significant differences in postoperative visual acuity, IOP and complications compared to the outcomes of laser iridotomy. Additionally, the need for IOP lowering agents was less in the primary phacoemulsification groups at 1 year after the operation.

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

REFERENCES

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Figure 1.

Intraocular pressure after laser iridotomy and phacoemulsification. At postoperative 1 month, the group of primary phacoemulsification shows significantly lower intraocular pressure compared with the group of laser iridotomy (p = 0.032), but there's no other significance difference statistically between two groups (by Mann-Whitney U-test). IOP = intraocular pressure; LI = laser iridotomy; PE= phacoemulsification. ^* p<0.05.

Figure 2.

BCVA after laser iridotomy and phacoemulsification. On the day after the operation, laser iridotomy group had the better outcome in their vision (log MAR) 0.62 ± 0.51 (p = 0.048), At 6 months after operation, primary phacoemulsification group has the better vision (log MAR) 0.07 ± 0.15 (p = 0.013), respectively. But other period, the vision outcomes between two groups show no significance difference (by Mann-Whitney U-test). BCVA = best corrected visual acuity; LI = laser iridotomy; 1.4 mmHg PE= phacoemulsification. ^*p<0.05.

Figure 3.

The need for intraocular pressure lowering agent after laser iridotomy and phacoemulsification. The need for intraocular pressure lowering agent is lower in the initial laser iridotomy and primary phacoemulsification at the point of one year after the operation (p = 0.031, Mann-Whitney U-test). IOP = intraocular pressure; LI = laser iridotomy; PE = phacoemulsification; POD = postoperative day.

Table 1.

Preoperative clinical characteristics

	LI (N = 45)	PE (N = 16)	p-value
Age	69.0 ± 8.53	66.8 ± 7.57	0.071^*
Sex (male:female)	14:31	3:13	0.344^†
Direction (right:left)	15:30	6:10	0.224^†
Hypertension	14	7	0.763^†
Diabetes mellitus	1	1	0.679^†
IOP (mm Hg)	50.34 ± 19.92	51.10 ± 18.55	0.661^*
BCVA (log MAR)	1.24 ± 0.43	1.75 ± 0.92	0.078^*
Axial length (mm)	22.13 ± 0.39	22.10 ± 0.44	0.483^*
ACD (mm)	2.37 ± 0.24	2.38 ± 0.46	0.321^*

Values are presented as mean ± SD unless otherwise indicated.

LI = laser iridotomy; PE= phacoemulsification; IOP = intraocular pressure; BCVA = best corrected visual acuity; ACD = anterior chamber depth.

^* Mann-whitney U-test;

^† Chi-square test.

Table 2.

Complications

	LI	PE
Loss of sight	0	0
Endophthalmitis	0	0
Hyphema	3	0
Bullous keratopathy	0	0
PCR	0	2
Remnant lens cortex	-	1

LI = laser iridotomy; PE= phacoemulsification; PCR = posterior capsular rupture.

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