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Abstract #21718 Published in IGR 10-3
Randomized trial of early phacoemulsification versus peripheral iridotomy to prevent intraocular pressure rise after acute primary angle closure
Lam DS; Leung DY; Tham CC; Li FC; Kwong YY; Chiu TY; Fan DSOphthalmology 2008; 115: 1134-1140
PURPOSE: To compare the efficacy of early phacoemulsification versus laser peripheral iridotomy (LPI) in the prevention of intraocular pressure (IOP) rise in patients after acute primary angle closure (APAC). DESIGN: Prospective randomized controlled trial. PARTICIPANTS: Sixty-two eyes of 62 Chinese subjects, with 31 eyes in each arm. METHODS: Subjects were randomized to receive either early phacoemulsification or LPI after aborting APAC by medications. Patients were followed up on day 1; week 1; and months 1, 3, 6, 12, and 18. Predictors for IOP rise were studied. MAIN OUTCOME MEASURES: Prevalence of IOP rise above 21 mmHg (primary) and number of glaucoma medications, IOP, and Shaffer gonioscopy grading (secondary). RESULTS: Prevalences of IOP rise for the LPI group were 16.1%, 32.3%, 41.9%, and 46.7% for the follow-ups at 3, 6, 12, and 18 months, respectively. There was only one eye (3.2%) in the phacoemulsification group that had IOP rise at all follow-up time points (P < 0.0001). Treatment by LPI was associated with significantly increased hazard of IOP rise (hazard ratio [HR], 14.9; 95% confidence interval [CI], 1.9-114.2; P = 0.009). In addition, a maximum IOP at presentation > 55 mmHg was associated with IOP rise (HR, 4.1; 95% CI, 1.3-13.0; P = 0.017). At 18 months, the mean number of medications required to maintain IOP ≤ 21 mmHg was significantly higher in the LPI group (0.90 ± 1.14) than in the phacoemulsification group (0.03 ± 0.18, P < 0.0001). Mean IOP for phacoemulsification group (12.6 ± 1.9 mmHg) was consistently lower than that of the LPI group (15.0 ± 3.4 mmHg, P = 0.009). Mean Shaffer grading for the phacoemulsification group (2.10 ± 0.76) was consistently greater than that of the LPI group (0.73 ± 0.64, P < 0.0001). CONCLUSION: Early phacoemulsification appeared to be more effective in preventing IOP rise than LPI in patients after abortion of APAC. High presenting IOP of > 55 mmHg is an added risk factor for subsequent IOP rise. For patients with coexisting cataract and presenting IOP of > 55 mmHg, early phacoemulsification can be considered as a definitive treatment to prevent IOP rise.
Dr. D.S. Lam, Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong, China. Dennislam_pub@cuhk.edu.hk
Classification:
9.3.1 Acute primary angle closure glaucoma (pupillary block) (Part of: 9 Clinical forms of glaucomas > 9.3 Primary angle closure glaucomas)
12.12.3 Phacoemulsification (Part of: 12 Surgical treatment > 12.12 Cataract extraction)
12.2 Laser iridotomy (Part of: 12 Surgical treatment)
