Comparing the use of phacoemulsification and combined surgery in angle-closure glaucoma

ABSTRACT

Introduction: This review compared phacoemulsification alone versus combined phacoemulsification with glaucoma filtration surgery in the surgical management of angle-closure glaucoma.

Areas covered: Phacoemulsification alone is generally safe with good predictable outcomes in angle-closure eyes. Studies have shown phacoemulsification alone significantly and sustainably reduces IOP in angle-closure eyes. In eyes with primary angle-closure and primary angle-closure glaucoma, the EAGLE study showed the superior efficacy and safety profile of lens extraction compared to laser iridotomy. Combined phacotrabeculectomy has the potential to achieve better IOP reduction and it is particularly useful in patients with advanced glaucoma. However, it carries higher ocular morbidity and long-term complications.

Expert commentary: The surgical approaches of either phacoemulsification alone or combined phacotrabeculectomy in angle-closure eyes depends on the lens status, classification of angle-closure and the severity of the glaucoma. The efficacy and safety profile of each surgical approach have to be weighed against risks and severity of disease. Combining phacoemulsification with glaucoma drainage implant is safe with good surgical outcomes and could be an alternative to phacotrabeculectomy. Combining phacoemulsification with micro-invasive glaucoma surgery may have a role in the management of early primary angle closure but further studies are required to provide supporting evidence.

KEYWORDS:

• Angle-closure glaucoma
• glaucoma drainage implant
• intraocular pressure
• micro-invasive glaucoma surgery phacoemulsification
• phacotrabeculectomy

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties

Additional information

Funding

This paper was not funded