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    Cataract surgery may benefit certain PAC/PACG patients


    St. Louis—There might be a role for lens extraction in certain scenarios for patients with primary angle-closure (PAC) or primary angle-closure glaucoma (PACG). This question is being addressed in the effectiveness of early lens extraction with IOL implantation for the treatment of PACG in the EAGLE study.

    “In such patients, the lens plays a major role in the pathogenesis of PAC and PACG. Those with the former have thicker lenses that are positioned more anteriorly and a decreased anterior chamber angle,” Anjali Bhorade, MD, commented.

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    However, she pointed out that the current studies of angle closure and cataract surgery are limited in that few patients were included, many studies were nonrandomized, and the methodologies varied greatly, making comparisons among the studies extremely difficult.

    In her attempt to determine if cataract surgery is beneficial in this patient population, she wanted to evaluate patients based on whether their cataracts were visually relevant, she explained. Those with visually relevant cataracts typically undergo a laser peripheral iridotomy (LPI) and if the IOP is controlled medically, the patients are monitored.

    Managing visually relevant cataracts in PAC

    However, there is a question about the appropriateness of managing these patients with phaco-trabeculectomy or phacoemulsification. Dr. Bhorade, associate professor of ophthalmology, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, recounted a study conducted by Tham and colleagues (Ophthalmology 2008; 115: 1267-73) in which 72 eyes with medically controlled IOP and a visually relevant cataract following a LPI were randomized to phacoemulsification or a phaco-trabeculectomy.

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    The results showed that the IOP decreased in both groups, but the difference between them did not reach statistical significance. The group with the combination therapy had fewer IOP medications but more postoperative complications compared with phacoemulsification alone.

    “If there are patients with a visually significant cataract whose IOP is medically controlled but they would like to decrease their medications, phacoemulsification might be a good choice,” she said.

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    Uncontrolled IOP

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