Anterior chamber angle widening greater after phacoemulsification in glaucoma patients: Study

Florida: Anterior chamber angle widening was found in individuals with primary angle-closure glaucoma (PACG) after surgery and was considerably higher after phacoemulsification compared to combined phacotrabeculectomy at all time periods, says a report published in the Journal of Glaucoma.

Glaucoma is the primary cause of blindness in adults aged 40 to 80, with a global incidence of 3.54 percent. The number of impacted patients is expected to rise from 76 million in 2020 to more than 110 million by 2040. Primary angle-closure glaucoma (PACG) is less prevalent in most populations than primary open-angle glaucoma (POAG); nonetheless, it is more common in Asia and may be underdiagnosed in other groups. Because there is a growing body of evidence indicating an anteriorly positioned and/or thick lens plays a substantial role in the development of PACG, Mojtaba Ghadamzadeh and colleagues undertook this study to examine the anterior chamber angle following two frequent PACG operations.

In this single-center, prospective, randomized clinical study, 110 glaucoma patients were assessed. Those with simultaneous PACG and senile cataracts who had no history of ocular surgery, trauma, or prolonged miotic usage were chosen. Patients who were only blind in one eye were also eliminated. Finally, 52 suitable participants were allocated at random to either phacoemulsification or phacotrabeculectomy surgery. The anterior section was imaged using a swept-source anterior segment optical coherence tomography system. The photos were graded by mask graders to determine the following characteristics before and after surgery: angle opening distance at 500 m, trabecular iris surface area at 500 m, and trabecular iris angle at 500 m.

The key findings are as follow:

1. In preoperative or postoperative visits, there was no significant difference between study groups in terms of best-corrected visual acuity, intraocular pressure (IOP), or the number of glaucoma drugs (P>0.076).

2. Furthermore, before surgery, there was no statistically significant difference in the observed angle parameters between the two groups (P>0.123).

3. All measured values were considerably higher in both groups after surgery (P0.0001). At the 6-month follow-up, the nasal angle opening distance at 500 m was 0.3830.027 vs. 0.3490.017, the trabecular iris surface area was 0.1410.007 vs. 0.1250.005, and the trabecular iris angle was 40.112.9 vs. 34.63.1 in the Phaco and Combined groups, respectively.

In conclusion, with solo cataract surgery, phacoemulsification with or without trabeculectomy results in a considerable decrease in IOP with a higher depth of the anterior chamber.

Reference:

Ghadamzadeh, M., Karimi, F., Ghasemi Moghaddam, S., & Daneshvar, R. (2022). Anterior Chamber Angle Changes in Primary Angle-closure Glaucoma Following Phacoemulsification Versus Phacotrabeculectomy: A Prospective Randomized Clinical Trial. In Journal of Glaucoma (Vol. 31, Issue 3, pp. 147–155). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/ijg.0000000000001977

Keywords: Glaucoma, phacoemulsification, phacotrabeculectomy, chamber angle, vision, blindness, open-angle glaucoma, Journal of Glaucoma,