Clinical Outcomes After Lens Extraction for Visually Significant Cataract in Eyes With Primary Angle Closure

Purpose: To examine the clinical outcomes of cataract extraction in eyes with primary angle closure (PAC) and coexisting cataract. Patients and Methods: Retrospective study of surgical outcomes after phacoemulsification and intraocular lens implantation in 55 eyes of 39 patients with PAC or occludable angles and visually symptomatic cataract. Approximately, 61.8% of eyes had received a peripheral iridotomy and 65% had evidence of glaucomatous optic neuropathy (GON). Results: At 7.2 months after cataract extraction, a statistically significant reduction in intraocular pressure (IOP) was observed in all eyes with PAC (median 3 mm Hg, P = <0.0001). The reduction in IOP was significantly greater in eyes with a higher preoperative IOP (P = <0.0001). On average, one less glaucoma medication was in use postoperatively (P = 0.01). Eyes with >180 degrees of peripheral anterior synechiae (PAS) preoperatively achieved a significantly greater reduction in IOP postoperatively compared with those with less PAS (7.5 vs. 4.4 mm Hg, P = 0.03). The observed reduction in IOP in eyes with PAC and GON was significantly greater compared with those without GON (5.6 vs. 2.5 mm Hg, P = 0.01). Visual acuity was significantly improved after cataract extraction by a mean of -0.23 LogMAR units (P = 0.0001). Conclusions: Contrary to earlier expectations, the observed reduction in postoperative IOP in eyes with PAC was significantly greater in the presence of a higher preoperative IOP, a larger number of glaucoma medication, narrower iridotrabecular angle width, and greater extent of PAS formation and in eyes with evidence of GON. Lens extraction seems to have a beneficial effect on IOP control in PAC, and is especially efficacious in more advanced cases.