Early Phacoemulsification After Acute Angle Closure in Patients With Coexisting Cataract

Purpose: The purpose of this study is to evaluate the effect of early phacoemulsification on the management of acute angle closure glaucoma in patients with coexisting cataract after initial treatment with medical therapy and laser peripheral iridotomy.

Patients and Methods: This study involved a retrospective analysis of patients presenting to the Maastricht University Medical Center+ with acute angle closure and coexisting cataract between 2005 and 2015. Patients were included after initial treatment with a standard protocol comprising topical and systemic medical therapy and laser peripheral iridotomy. Patients underwent small-incision phacoemulsification with intraocular lens implantation into the capsular bag by experienced surgeons within 3 months of the acute angle closure episode. The effect on intraocular pressure, number of glaucoma medications, visual acuity, and complications was assessed.

Results: A total 35 patients were included in the study (mean age, 71 +/- 10 y; 20% male; mean refractive error, +1.6 +/- 1.8 diopters). The mean duration between acute angle closure episode and phacoemulsification was 37 +/- 22 days. There were no complications. Intraocular pressure decreased in all patients from 17.0 +/- 8.2 mm Hg to 13.2 +/- 3.9 mm Hg after 3 months (P = 0.008), whereas the mean number of glaucoma medications decreased from 2.9 +/- 1.1 to 0.7 +/- 0.9 (P <0.001), with 56% of patients discontinuing all medications. Visual acuity improved from 0.9 +/- 0.9 log MAR to 0.2 +/- 0.3 logMAR (P <0.001).

Conclusions: Early phacoemulsification with intraocular lens implantation results in a reduced intraocular pressure and number of glaucoma medications after an acute angle closure glaucoma crisis in patients with coexisting cataract. Although surgery may be challenging, the results are promising, with significant improvement in visual acuity in most patients.