Uncontrolled primary angle closure glaucoma: results of early intercapsular cataract extraction and posterior chamber lens implantation

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Abstract
In this study we retrospectively evaluated the effect of intercapsular or extracapsular cataract extraction and posterior chamber lens implantation in 67 eyes of 57 patients with different types of primary angle closure glaucoma (PACG) in combination with cataract. We subdivided this patient population into three groups, based on the preoperative methods of intraocular pressure (IOP) control. The best results were obtained in patients with acute PACG (55% IOP reduction) and in patients with uncontrolled PACG (44% IOP reduction). In the other PACG groups an IOP reduction of between 20 and 33% was achieved. A long-term postoperative IOP of less than 21 mmHg was established in 63 eyes or 94%. In 91% the glaucoma medication was reduced, 65% of all eyes needed no glaucoma medication post-operatively. We conclude that an intercapsular cataract extraction with PC-IOL implantation should be considered in both controlled and uncontrolled PACG in patients with cataract, instead of filtering surgery or combined procedures. Even in eyes with relatively good visual acuity, cataract extraction might be considered as a means of achieving glaucoma control.

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