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

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          Abstract

          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.
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            Author and article information

            Journal
            OPH
            Ophthalmologica
            10.1159/issn.0030-3755
            Ophthalmologica
            S. Karger AG
            0030-3755
            1423-0267
            2003
            October 2003
            20 August 2003
            : 217
            : 5
            : 325-328
            Affiliations
            Department of Ophthalmology, National Nagasaki Medical Center, Nagasaki, Japan
            Article
            71346 Ophthalmologica 2003;217:325–328
            10.1159/000071346
            12913321
            © 2003 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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