Managing Primary Angle Closure Glaucoma – The Role of Lens Extraction in this Era



Nafees Baig1, 2, Ka-Wai Kam1, 3, Clement C.Y. Tham1, 3, *
1 Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People’s Republic of China
2 Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, People’s Republic of China
3 Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, People’s Republic of China


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© Baig et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong, Tel: (852) 3943 5823; Fax: (852) 2816 7093; Email: clemtham@cuhk.edu.hk


Abstract

Trabeculectomy has been the gold standard in reducing intraocular pressure (IOP) in glaucoma patients, no matter it is angle closure or open angle glaucoma. However in primary angle closure glaucoma, no matter the lens is cataractous or not, it is likely to be pathological, this thicker than usual lens, with or without a more anterior position, is often regarded as a strong contributing factor to angle closure. Lens extraction, no matter it is cataractous or clear, can theoretically eliminate this anatomical predisposing factor of angle closure, and thus IOP can be reduced. Based on recent results of a number of clinical trials, lens extraction alone or in combination with other IOP-lowering surgeries, may therefore play a more important role in the treating primary angle closure glaucoma. In cases when greater IOP-lowering effect is needed or if drug dependency has to be minimized, combined procedures, such as phacotrabeculectomy, can be considered, but the surgical risk can be higher than lens extraction alone.

Keywords: Acute primary angle closure, lens extraction, primary angle closure glaucoma, trabeculectomy.