Phacoemulsification can serve as a first-line treatment for acute angle-closure glaucoma while also correcting refractive error. Photo: Michael Cymbor, OD. Click image to enlarge.

Sudden pressure increases that accompany acute angle closure can have devastating visual consequences. Prompt treatment is required to re-open the angle, often consisting of laser peripheral iridotomy to improve pupillary block. This approach doesn’t always open up narrow angles, however. Removing the lens via phacoemulsification is an alternative approach for deepening the anterior chamber, and in fact a recent article published in the Journal of Cataract and Refractive Surgery reported that phaco was both safe and effective for this purpose.

The study included 50 eyes of patients who underwent phaco within a week of presenting with acute angle-closure glaucoma and receiving IOP lowering treatment. All eyes were imaged and measured using anterior segment OCT and Pentacam.

The mean preoperative IOP was 40.3mm Hg, which decreased to 14.9mm Hg within one week of operation. Further pressure lowering was observed at postop weeks four and 12, to 12.4 and 11.44 mmHg, respectively.

The mean preoperative temporal angle width was 18.13˚, which widened respectively to 32.6˚, 34.6˚ and 36.2˚ at one, four and 12 weeks postop. The mean preoperative nasal angle width also increased from 17.8˚ to 32.7˚, 34.5˚ and 36.2˚ at postop weeks one, four and 12, respectively.

The researchers concluded in their paper that “early phacoemulsification is very effective in treating acute angle-closure glaucoma cases immediately after medical control of high IOP and resolution of corneal edema.”