The Clinical Outcomes of Cataract Extraction by Phacoemulsification in Eyes With Primary Angle-Closure Glaucoma (PACG) and Co-Existing Cataract

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Abstract
Purpose: To evaluate the clinical outcomes of minimally invasive cataract extraction by phacoemulsification, with primary intraocular lens implantation, in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract. Materials and Methods: Consecutive primary angle-closure glaucoma patients with co-existing visually significant cataract were invited to participate in this prospective study. After obtaining informed consent, cataract extraction by phacoemulsification through a clear corneal incision was performed under topical anesthesia. Foldable intraocular lenses were implanted in the same setting. These patients were then followed up for a minimum of 1 year. Outcome measures included intraocular pressure (IOP), requirement for glaucoma drugs, and visual acuity. Results: Twenty-one primary angle-closure glaucoma eyes of 21 patients were recruited. Mean age (± SD) was 73.7 ± 8.1 years (range, 60-87 years). There were 12 female patients and 9 male patients, with 13 right eyes and 8 left eyes. Nine eyes (42.9%) had history of acute primary angle closure. Mean follow-up duration was 20.7 ± 3.6 months (range, 13-26 months). Intraocular pressure was decreased from a mean preoperative level of 19.7 ± 6.1 mm Hg (range, 11 mm Hg-40 mm Hg) to 15.5 ± 3.9 mm Hg (range, 9 mm Hg-26 mm Hg) at final follow-up (P = 0.022) (paired t test). The number of glaucoma eye drops required was decreased from a mean preoperative level of 1.91 ± 0.77 (range, 1-3) to 0.52 ± 0.87 (range, 0-3) at final follow-up (P < 0.001) (paired t test). In 10 eyes (47.6%), visual acuity improved significantly after surgery. In 9 eyes (42.9%), visual acuity remained the same. In 2 eyes (9.5%), visual acuity deteriorated significantly after surgery. Mean cup-to-disc ratio was 0.6 ± 0.2 (range, 0.3-0.9) preoperatively, and 0.7 ± 0.2 (range, 0.3-0.9) postoperatively (P = 0.047) (paired t test). Conclusions: In primary angle-closure glaucoma patients with co-existing cataract, cataract extraction alone (by phacoemulsification) can significantly reduce both intraocular pressure and the requirement for glaucoma drugs.

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