Crystalline lens extraction in the management of primary angle-closure glaucoma may be useful for long-term control of intraocular pressure.
A report by a research team at the National Eye Centre in Singapore supports lens extraction in the management of primary angle-closure glaucoma (PACG) for long-term control of intraocular pressure (IOP).
This indication is especially valid in patients with hypermetropia and a thick, anteriorly arched crystalline lens.
Angle closure is an important cause of glaucoma worldwide, with a prevalence of patients (85%) in Asia.
It is caused by an obstruction of the trabecularis by the iris, which induces an impaired outflow of aqueous humour. This leads to increased IOP and eventually to glaucomatous optic neuropathy.
Since pupillary blockage is considered the primary cause of PACG, the first therapeutic approach is laser peripheral iridotomy, which serves to eliminate the pupillary blockage and widen the angle.
This treatment, however, may be unsuccessful, in which case phacoemulsification of the crystalline lens may be considered, either alone or combined with lysis of the goniosynecias or filtering surgery (trabeculectomy and phacotrabeculectomy).
The authors of the research, Sameer Trikha, Shamira A. Perera, Rahat Husain and Tin Aung, claim that the benefits of this intervention include anatomical angle opening, IOP reduction and improved vision.
The evidence base supporting this intervention has increased based on recent clinical trials, case-control studies and cohort studies.
New elements have also emerged from imaging technologies, such as anterior segment OTC, which are able to provide information on the mechanical aspects of the role of the crystalline lens in angle closure, for example by measuring its thickness and curvature.
For more details see the article published in the No. 2 2015 of Current Opinion in Ophthalmology
Dr. Carmelo Chines
Direttore responsabile
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