Intraocular pressure control following phacoemulsification in patients with chronic angle closure glaucoma.

OBJECTIVES: To evaluate intraocular pressure (IOP) and glaucoma control following phacoemulsification with posterior chamber intraocular lens implantation in patients who had chronic angle closure glaucoma (CACG) whose peripheral anterior synechiae (PAS) were less than 270 degrees.

DESIGN: Non-randomized consecutive cases series.

PARTICIPANTS: CACG cases at the glaucoma service, Ramathibodi Hospital who underwent Neodymium YAG laser peripheral iridotomy (PI) and subsequently received or did not receive anti-glaucoma medication.

MATERIAL AND METHOD: Retrospective analysis of CACG patients who had PAS 270 degrees or less and underwent YAG-PI with or without anti-glaucoma medication to control IOP at 21 mmHg or less. The IOP and number of anti-glaucoma medication used at 1, 3 and 6 months were measured. Patients were classified into 2 Groups according to degree of PAS: Group 1 were patients who had PAS 180 degrees or less and Group 2 were those whose PAS was between 181 degrees and 270 degrees.

MAIN OUTCOME MEASURES: The IOP and number of anti-glaucoma medication at baseline and postoperatively at 1, 3 and 6 months were compared by nonparametric statistics.

RESULTS: There were 28 patients (48 eyes) in the present study. Twenty two were females and 6 were males. Patients' age ranged from 45 to 76 years old with a mean of 55 +/- 6.5 years. Of the 48 eyes, 34 were in Group 1 and 14 were in Group 2. In Group 1, the mean baseline IOP was 20 +/- 2.5 mmHg. and the average number of preoperative anti-glaucoma medication used was 0.08. At 1, 3 and 6 months postoperatively, the IOPs were 16.2 +/- 2.2, 17.1 +/- 2.0, 18.1 +/- 1.4 mmHg. respectively with an average number of anti-glaucoma medications of 0, 0.3 and 0.3, respectively, whereas in Group 2, the mean baseline IOP was 22 +/- 3.8 mmHg and mean preoperative number of anti-glaucoma was 1.8, whereas postoperatively, the IOPs at 1, 3 and 6 months were 17.1 +/- 2.2, 17.3 +/- 1.8, and 17.1 +/- 1.7 mmHg, with an average number of 1.1, 1.4 and 1.4 anti-glaucoma medications used, respectively. When compared between the 2 Groups, Group 1 had a significant difference in IOP control at 1 and 3 months and less use of antiglaucoma medications than Group 2 up to at least 6 months.

CONCLUSION: Phacoemulsification in CACG helped control of glaucoma. There was a statistically significant difference in IOP reduction and number of anti-glaucoma medication used before and after phacoemulsification in the CACG patients whose PAS did not exceed 270 degrees at least up to 6 months.