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      Phacoemulsification and Intraocular Lens Implantation for Angle Closure Glaucoma after the Relief of Pupillary Block

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          Purpose: We studied the surgical outcomes of phacoemulsification and intraocular lens (IOL) implantation for cataract and/or uncontrolled intraocular pressure (IOP) in eyes with angle closure glaucoma. Setting: Department of Ophthalmology, National Nagasaki Medical Center, Nagasaki, Japan. Methods: Eighteen eyes from 15 patients after laser iridotomy (17 eyes) or peripheral iridectomy (1 eye) had undergone surgery and were studied. We used an iris retractor in 7 eyes due to insufficient mydriasis and a capsular tension ring in 2 eyes due to phacodonesis during the operation. The patients were followed up for at least 6 months (13.8 ± 7.2 months; range: 6–36 months). Results: The mean IOP significantly decreased from 17.4 ± 8.1 to 13.5 ± 3.3 mm Hg at 6 months after surgery. The IOP was below 21 mm Hg in all eyes. The visual acuity was not worsened in any eyes and became better than 2 Snellen lines in 14 eyes. The corneal endothelial cell count decreased from 2,365 ± 517 to 1,960 ± 661/mm<sup>2</sup> (18.3 ± 17.2%). Conclusions: Phacoemulsification and IOL implantation is useful in IOP control for angle closure glaucoma after relief of pupillary block. However, we should take care of operative complications because of a shallow anterior chamber, poor mydriasis and zonular weakness.

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          Combined phacoemulsification and goniosynechialysis for uncontrolled chronic angle-closure glaucoma after acute angle-closure glaucoma.

          To evaluate combined phacoemulsification, posterior chamber intraocular lens (PCIOL) implantation, and goniosynechialysis (phaco-GSL) prospectively in eyes with more than 180 degrees of peripheral anterior synechiae (PAS) and uncontrolled intraocular pressure (IOP) when performed within 6 months of an attack of acute angle-closure glaucoma (ACG). Prospective, noncontrolled clinical trial. Patients who had presented with acute ACG and had persistently uncontrolled IOP despite successful laser iridotomy for pupillary block and argon laser peripheral iridoplasty for continued appositional closure after iridotomy. After the completion of phacoemulsification and posterior chamber lens implantation, goniosynechialysis was performed in 52 eyes of 48 patients. Postoperative visual acuity, IOP, extent of PAS, and number of medications, if any, required for IOP control. Intraocular pressure was less than 20 mmHg in 47 eyes (90.4%) without medications; 4 were controlled with medications and 1 required filtration. Mean extent of PAS was reduced from 310 degrees to 60 degrees. Peripheral anterior synechiae formation or IOP elevation did not recur after 3 months after surgery up to 6 years. Eight patients achieved 20/20 visual acuity, while 44 patients had less than 20/20 visual acuity. No patient had worse visual acuity after surgery compared to before surgery. Phaco-GSL and PCIOL implantation is effective in reducing PAS and IOP and improving visual acuity in eyes with persistent chronic ACG when performed within 6 months after treatment for acute ACG.

            Author and article information

            S. Karger AG
            October 2003
            20 August 2003
            : 217
            : 5
            : 325-328
            Department of Ophthalmology, National Nagasaki Medical Center, Nagasaki, Japan
            71346 Ophthalmologica 2003;217:325–328
            © 2003 S. Karger AG, Basel

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            Page count
            Tables: 3, References: 11, Pages: 4
            Original Paper


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