scholarly journals Clear Lens Extraction in Glaucoma (Is it still a controversy?)

2020 ◽  
Vol 36 (2) ◽  
Author(s):  
Syed Shoeb Ahmad
Keyword(s):  
Angle Closure Glaucoma ◽  
Advanced Age ◽  
Angle Closure ◽  
Lens Extraction ◽  
Lens Thickness ◽  
Primary Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Lens Position ◽  
Anatomical Basis ◽  
Strategic Role

The lens appears to play a strategic role in the etiopathogenesis of glaucoma. This is not a new concept. In 1891 Priestley Smith had noted that some patients diagnosed with glaucoma demonstrated shallow anterior chambers even before the development of the disease (glaucoma). He concluded that this feature could be attributed to the disproportion between the size of the eyeball and the lens1. Lowe (1969) mentioned that the anatomical basis of primary angle closure glaucoma (PACG) lies in two important “constitutional” factors (lens position and thickness) and two other factors of lesser importance related to advanced age (increase in lens thickness and anterior lens displacement)2.

scholarly journals Managing Primary Angle Closure Glaucoma – The Role of Lens Extraction in this Era

2016 ◽  
Vol 10 (1) ◽  
pp. 86-93 ◽  
Author(s):  
Nafees Baig ◽  
Ka-Wai Kam ◽  
Clement C.Y. Tham
Keyword(s):  
Gold Standard ◽  
Open Angle Glaucoma ◽  
Angle Closure Glaucoma ◽  
Angle Closure ◽  
Predisposing Factor ◽  
Lens Extraction ◽  
Primary Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Anterior Position

Trabeculectomy has been the gold standard in reducing intraocular pressure (IOP) in glaucoma patients, no matter it is angle closure or open angle glaucoma. However in primary angle closure glaucoma, no matter the lens is cataractous or not, it is likely to be pathological, this thicker than usual lens, with or without a more anterior position, is often regarded as a strong contributing factor to angle closure. Lens extraction, no matter it is cataractous or clear, can theoretically eliminate this anatomical predisposing factor of angle closure, and thus IOP can be reduced. Based on recent results of a number of clinical trials, lens extraction alone or in combination with other IOP-lowering surgeries, may therefore play a more important role in the treating primary angle closure glaucoma. In cases when greater IOP-lowering effect is needed or if drug dependency has to be minimized, combined procedures, such as phacotrabeculectomy, can be considered, but the surgical risk can be higher than lens extraction alone.

scholarly journals Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial

The Lancet ◽  
2016 ◽  
Vol 388 (10052) ◽  
pp. 1389-1397 ◽  
Author(s):  
Augusto Azuara-Blanco ◽  
Jennifer Burr ◽  
Craig Ramsay ◽  
David Cooper ◽  
Paul J Foster ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Angle Closure Glaucoma ◽  
Angle Closure ◽  
Lens Extraction ◽  
Primary Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Randomised Controlled

scholarly journals Development of a new algorithm for treatment of primary angle closure glaucoma

2018 ◽  
Vol 9 (2) ◽  
pp. 20-29
Author(s):  
N. I. Kurysheva ◽  
V. N. Trubilin ◽  
S. G. Kapkova ◽  
L. V. Lepeshkina
Keyword(s):  
Diabetes Mellitus ◽  
Corneal Endothelium ◽  
Angle Closure Glaucoma ◽  
Angle Closure ◽  
Control Group ◽  
Lens Thickness ◽  
Primary Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Pigment Deposition

Purpose – to develop a new algorithm for treatment of primary angle closure glaucoma (PACG) based on laser peripheral iridotomy (PI) and selective laser trabeculoplasty (SLT) and to determine its indications and contraindications. 68 eyes with PACG were observed for 6 years. These patients had undergone PI and then SLT. The control group included 74 POAG eyes of the same age and stage of glaucoma. The effectiveness of SLT was assessed using the Kaplan-Meier survival analysis. The risk factors for SLT failure in the long-term period were studied to determine the indications and contraindications for this treatment algorithm, and the condition of corneal endothelium in dynamics was investigated using confocal microscopy. The hypotensive effect of SLT in PACG was worse than in POAG: 90 and 93% respectively one year after SLT, and 16 and 21% six years after SLT (log rank test, p=0.195). The following factors of SLT failure were common for both forms of glaucoma: IOP >24 mm Hg, corneal thickness ≤540 µm, corneal hysteresis <7 mm Hg and age of patients >68 years. The extension of laser action <1800 and lens thickness >4.8 mm were additional predictors of SLT failure in PACG. In both forms of glaucoma, diabetes mellitus, age of patients and duration of the disease before SLT had a negative effect on the condition of corneal endothelium. The anterior-posterior axis and the presence of pigment deposition on the endothelium were significant in PACG. The proposed algorithm for PACG treatment, including the initial performance of PI and then SLT, is an effective method of treating this form of glaucoma, provided that the opening of the anterior chamber angle is sufficient (at least half) and the lens thickness is no more than 4.8 mm. The initially high IOP, the age of patients over 68 and a thin cornea (<540 μm) worsen the SLT prognosis. Moreover, diabetes mellitus and the presence of pigment deposition on the endothelium along with long-term glaucoma history increase the risk of corneal endothelium damage after SLT.

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