Intraocular pressure outcome after phacoemulsification and intraocular lens implantation in chronic angle closure glaucoma patients without extensive peripheral anterior synechiae

Background:Cataract extraction surgery significantly decreases intraocular pressure (IOP) in patients with various forms of angle closure glaucoma (ACG). However, most reports did not specify the circumferential extent of peripheral anterior synechiae (PAS). Objective: Evaluate IOP after phacoemulsification with intraocular lens (IOL) implantation in chronic ACG patients without extensive PAS. Materials and methods: Data of chronic ACG patients with documented peripheral PAS <180 degrees and clinically significant cataract, who underwent phacoemulsification with IOL implantation at King Chulalongkorn Momorial Hospital between May 2002 and June 2007 were reviewed retrospectively. Baseline characteristics as gender, degree of PAS, IOP, and number of medications were collected. The outcomes were post-operative IOP at 6, 12, and 18 months, and number of hypotensive medications. Results: Twenty-five eyes from 25 patients (mean age: 73.0 years old) were included in this study. Twenty-three out of 25 patients were female, and 17 had PAS less than 90 degrees. Pre-operative mean IOP was 15.6 mmHg, while pre-operative median (Q₁, Q₃) number of hypotensive medications was 2 (1, 2). After operation, statistically significant lower IOPs were seen at all time points. Mean IOP at 6, 12, and 18 months were 12.4, 11.0, and 11.9 mmHg respectively. In addition, post-operative number of hypotensive medication was also statistically significantly less than baseline, with median (Q₁, Q₃) 1 (0, 1), and 20% of these eyes were medication-free. Conclusion: Phacoemulsification and IOL implantation surgery alone in chronic ACG patients without extensive PAS can significantly lower IOP up to 18 months postoperatively.