Comparison of Intraocular Pressure After Phacoemulsification Compared to Laser Peripheral Iridotomy (LPI) in Acute Primary Angle Closure (APAC) Patients: A Systematic Review
Abstract
Aim: To compare IOP in APAC patients after phacoemulsification compared to LPI.
Background: Acute primary angle closure (APAC) is a type of PACG and an important cause of blindness in East Asia. In APAC patients, both LPI and phacoemulsification have been shown to be effective in controlling elevated IOP. Knowledge and information about changes in IOP after phacoemulsification and LPI in APAC patients, which is one of the criteria for successful APAC management, can be a reference as well as a consideration for choosing an effective treatment for APAC patients.
Results: Of the 15 articles reviewed, 84% of patients who received phacoemulsification intervention experienced >50% reduction and 24.3% of patients experienced <50% decrease in post-op IOP compared with the mean pre-op IOP. While patients who received LPI intervention, 80.5% of patients experienced >50% reduction in IOP and 19.4% of patients experienced <50% reduction in IOP post-op compared with the mean pre-op IOP.
Conclusion: There were decreases in IOP of APAC patients after phacoemulsification or LPI. In addition, there are differences in the decrease in IOP of APAC patients after phacoemulsification compared to LPI.
Clinical Significance: Phacoemulsification and LPI are effective for lowering IOP in the early stages of an acute attack. LPI is the preferred procedure according to most guidelines because it is relatively non-invasive, easy to administer on an outpatient basis, and has a lower risk of complications. Phacoemulsificatin has been shown to be a more effective treatment than LPI for IOP reduction in early and medium-term IOP controls.
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References
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29. Hou X, Hu D, Cui Z, Zhou J, Cai L, Wang Y. Small-incision phacotrabeculectomy versus phacoemulsification in refractory acute primary angle closure with cataract. BMC Ophthalmol. 2015;15:1–6.
30. Moghimi S, Hashemian H, Chen R, Johari M, Mohammadi M, Lin SC. Early phacoemulsification in patients with acute primary angle closure. J Curr Ophthalmol. 2016;27:70–5.
31. Su CW, Chen HY. Acute angle closure in the setting of high axial myopia: A case report. Am J Ophthalmol Case Reports. 2016;1:31–3.
32. Moghimi S, Chen R, Johari M, Bijani F, Mohammadi M, Khodabandeh A, et al. Changes in Anterior Segment Morphology after Laser Peripheral Iridotomy in Acute Primary Angle Closure. Am J Ophthalmol. 2016;166:133–40.
33. Sakai H, Yonahara M, Sakai M. Recurrent Uveal Effusion after Laser Iridotomy. Case Rep Ophthalmol. 2017;8:26–30.
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35. Patthanathamrongkasem. Refractive Outcome after Cataract Surgery in Acute Primary Angle Closure and Primary Angle Closure Patients. 2017;100.
36. Römkens HCS, Beckers HJM, Schouten JSAG, Nuijts RMMA, Berendschot TTJM, Breusegem CM, et al. Early Phacoemulsification after Acute Angle Closure in Patients with Coexisting Cataract. J Glaucoma. 2018;27:711–6.
37. Enkhzul. PRIMARY PHACOEMULSIFICATION WITH INTRAOCULAR LENS IMPLANTATION FOR ACUTE PRIMARY ANGLE-CLOSURE GLAUCOMA. 2018;33:2019.
38. Su WW. Acute primary angle-closure in Sturge-Weber syndrome. Am J Ophthalmol Case Reports. 2018;10:101–4.
39. Moghimi S, Bijani F, Chen R, Yasseri M, He M, Lin SC, et al. Anterior Segment Dimensions Following Laser Iridotomy in Acute Primary Angle Closure and Fellow Eyes. Am J Ophthalmol. 2018;186:59–68.
40. Fang A, Wang P, He R, Qu J. Surgical peripheral iridectomy via a clear-cornea phacoemulsification incision for pupillary block following cataract surgery in acute angle closure. BMC Ophthalmol. 2018;18:1–6.
41. Baek SU, Kim KH, Lee JY, Lee KW. Long-term Intraocular Pressure Elevation after Primary Angle Closure Treated with Early Phacoemulsification. Korean J Ophthalmol. 2018;32:108.
42. Tian T, Li M, Pan Y, Cai Y, Fang Y. The effect of phacoemulsification plus goniosynechialysis in acute and chronic angle closure patients with extensive goniosynechiae. BMC Ophthalmol. 2019;19:1–8.
43. Lin YH, Wu CH, Huang SM, Hsieh C, Chen HSL, Ku WC, et al. Early versus Delayed Phacoemulsification and Intraocular Lens Implantation for Acute Primary Angle-Closure. J Ophthalmol. 2020;2020.
44. Chan PP, Pang JC, Tham CC. Acute primary angle closure–treatment strategies, evidences and economical considerations. Eye. 2019;33:110–9.
45. Radhakrishnan S, Chen PP, Junk AK, Nouri-Mahdavi K, Chen TC. Laser Peripheral Iridotomy in Primary Angle Closure: A Report by the American Academy of Ophthalmology. Ophthalmology. 2018;125:1110–20.
46. Boey PY, Singhal S, Perera SA, Aung T. Conventional and emerging treatments in the management of acute primary angle closure. Clin Ophthalmol. 2012;6:417–24.
2. Aung T, Friedman DS, Chew PTK, Ang LP, Gazzard G, Lai YF, et al. Long-term outcomes in asians after acute primary angle closure. Ophthalmology. 2004;111:1464–9.
3. Chan EWE, Li X, Tham YC, Liao J, Wong TY, Aung T, et al. Glaucoma in Asia: Regional prevalence variations and future projections. Br J Ophthalmol. 2016;100:78–85.
4. Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: A systematic review and meta-analysis. Ophthalmology. 2014;121:2081–90.
5. Seah. Incidence of Acute Primary Angle-closure Glaucoma in Singapore. J Chem Inf Model. 1997;01:1689–99.
6. Ramesh S, Maw C, Sutton CJ, Gandhewar JR, Kelly SP. Ethnic aspects of acute primary angle closure in a UK multicultural conurbation. Eye. 2005;19:1271–5.
7. Cheng JW, Cheng SW, Ma XY, Cai JP, Li Y, Wei RL. The prevalence of primary glaucoma in mainland China: A systematic review and meta-analysis. J Glaucoma. 2013;22:301–6.
8. Wang X, Liu X, Huang L, Fang S, Jia X, Xiao X, et al. Mutation Survey of Candidate Genes and Genotype–Phenotype Analysis in 20 Southeastern Chinese Patients with Axenfeld–Rieger Syndrome. Curr Eye Res. 2018;43:1334–41.
9. Wiggs JL, Pasquale LR. Genetics of glaucoma. Hum Mol Genet. 2017;26:R21–7.
10. Ahram DF, Alward WL, Kuehn MH. The genetic mechanisms of primary angle closure glaucoma. Eye. 2015;29:1251–9.
11. Rong SS, Tang FY, Chu WK, Ma L, Yam JCS, Tang SM, et al. Genetic Associations of Primary Angle-Closure Disease A Systematic Review and Meta-analysis. Ophthalmology. 2016;123:1211–21.
12. Aung T, Khor CC. Glaucoma Genetics: Recent Advances and Future Directions. Asia-Pacific J Ophthalmol. 2016;5:256–9.
13. ALSBIRK PH. VARIATION AND HERITABILITY OF OCULAR DIMENSIONS: A Population Study among Adult Greenland Eskimos. Acta Ophthalmol. 1977;55:443–56.
14. Day AC, Baio G, Gazzard G, Bunce C, Azuara-Blanco A, Munoz B, et al. The prevalence of primary angle closure glaucoma in European derived populations: A systematic review. Br J Ophthalmol. 2012;96:1162–7.
15. Paul C, Sengupta S. Subjects and Methods : Prevalence of glaucoma in Eastern India : The Hooghly River Glaucoma Study Statistical Analysis Used : Abstract Context : Results : Aims : Conclusions : 2016;64:2016.
16. Song P, Wang J, Bucan K, Theodoratou E, Rudan I, Chan KY. National and subnational prevalence and burden of glaucoma in China: A systematic analysis. J Glob Health. 2017;7:1–18.
17. Liang Y, Friedman DS, Zhou Q, Yang XH, Sun LP, Guo L, et al. Prevalence and characteristics of primary angle-closure diseases in a rural adult Chinese population: The Handan eye study. Investig Ophthalmol Vis Sci. 2011;52:8672–9.
18. He M, Foster PJ, Ge J, Huang W, Zheng Y, Friedman DS, et al. Prevalence and clinical characteristics of glaucoma in adult Chinese: A population-based study in Liwan District, Guangzhou. Investig Ophthalmol Vis Sci. 2006;47:2782–8.
19. Lowe RF. Prima1Ry Angle-Closure Glaucom4a *. 1964;191–5.
20. Amerasinghe N, Zhang J, Thalamuthu A, He M, Vithana EN, Viswanathan A, et al. The heritability and sibling risk of angle closure in Asians. Ophthalmology. 2011;118:480–5.
21. Kavitha S, Zebardast N, Palaniswamy K, Wojciechowski R, Chan ES, Friedman DS, et al. Family history is a strong risk factor for prevalent angle closure in a south Indian population. Ophthalmology. 2014;121:2091–7.
22. Zebardast N, Kavitha S, Palaniswamy K, Sengupta S, Kader MA, Raman G, et al. Angle Closure Phenotypes in Siblings of Patients at Different Stages of Angle Closure. Ophthalmology. 2016;123:1622–4.
23. Salmon JF. Predisposing factors for chronic angle-closure glaucoma. Prog Retin Eye Res. 1999;18:121–32.
24. Zhi ZM, Lim ASM, Wong TY. B Rief R Eports. 2003;60:534–6.
25. Kurimoto Y, Park M, Sakaue H, Kondo T. Changes in the anterior chamber configuration after small-incision cataract surgery with posterior chamber intraocular lens implantation. Am J Ophthalmol. 1997;124:775–80.
26. Yang CH, Hung PT. Intraocular lens position and anterior chamber angle changes after cataract extraction in eyes with primary angle-closure glaucoma. J Cataract Refract Surg. 1997;23:1109–13.
27. Yazdani S, Akbarian S, Pakravan M, Afrouzifar M. Prevalence of angle closure in siblings of patients With primary angle-closure glaucoma. J Glaucoma. 2017;24:149–53.
28. Baig N, Kam K-W, Tham CCY. Managing Primary Angle Closure Glaucoma – The Role of Lens Extraction in this Era. Open Ophthalmol J. 2016;10:86–93.
29. Hou X, Hu D, Cui Z, Zhou J, Cai L, Wang Y. Small-incision phacotrabeculectomy versus phacoemulsification in refractory acute primary angle closure with cataract. BMC Ophthalmol. 2015;15:1–6.
30. Moghimi S, Hashemian H, Chen R, Johari M, Mohammadi M, Lin SC. Early phacoemulsification in patients with acute primary angle closure. J Curr Ophthalmol. 2016;27:70–5.
31. Su CW, Chen HY. Acute angle closure in the setting of high axial myopia: A case report. Am J Ophthalmol Case Reports. 2016;1:31–3.
32. Moghimi S, Chen R, Johari M, Bijani F, Mohammadi M, Khodabandeh A, et al. Changes in Anterior Segment Morphology after Laser Peripheral Iridotomy in Acute Primary Angle Closure. Am J Ophthalmol. 2016;166:133–40.
33. Sakai H, Yonahara M, Sakai M. Recurrent Uveal Effusion after Laser Iridotomy. Case Rep Ophthalmol. 2017;8:26–30.
34. Lee EJ, Kim TW, Lee KM, Lee SH, Kim H. Factors associated with the retinal nerve fiber layer loss after acute primary angle closure: A prospective EDI-OCT study. PLoS One. 2017;12:1–14.
35. Patthanathamrongkasem. Refractive Outcome after Cataract Surgery in Acute Primary Angle Closure and Primary Angle Closure Patients. 2017;100.
36. Römkens HCS, Beckers HJM, Schouten JSAG, Nuijts RMMA, Berendschot TTJM, Breusegem CM, et al. Early Phacoemulsification after Acute Angle Closure in Patients with Coexisting Cataract. J Glaucoma. 2018;27:711–6.
37. Enkhzul. PRIMARY PHACOEMULSIFICATION WITH INTRAOCULAR LENS IMPLANTATION FOR ACUTE PRIMARY ANGLE-CLOSURE GLAUCOMA. 2018;33:2019.
38. Su WW. Acute primary angle-closure in Sturge-Weber syndrome. Am J Ophthalmol Case Reports. 2018;10:101–4.
39. Moghimi S, Bijani F, Chen R, Yasseri M, He M, Lin SC, et al. Anterior Segment Dimensions Following Laser Iridotomy in Acute Primary Angle Closure and Fellow Eyes. Am J Ophthalmol. 2018;186:59–68.
40. Fang A, Wang P, He R, Qu J. Surgical peripheral iridectomy via a clear-cornea phacoemulsification incision for pupillary block following cataract surgery in acute angle closure. BMC Ophthalmol. 2018;18:1–6.
41. Baek SU, Kim KH, Lee JY, Lee KW. Long-term Intraocular Pressure Elevation after Primary Angle Closure Treated with Early Phacoemulsification. Korean J Ophthalmol. 2018;32:108.
42. Tian T, Li M, Pan Y, Cai Y, Fang Y. The effect of phacoemulsification plus goniosynechialysis in acute and chronic angle closure patients with extensive goniosynechiae. BMC Ophthalmol. 2019;19:1–8.
43. Lin YH, Wu CH, Huang SM, Hsieh C, Chen HSL, Ku WC, et al. Early versus Delayed Phacoemulsification and Intraocular Lens Implantation for Acute Primary Angle-Closure. J Ophthalmol. 2020;2020.
44. Chan PP, Pang JC, Tham CC. Acute primary angle closure–treatment strategies, evidences and economical considerations. Eye. 2019;33:110–9.
45. Radhakrishnan S, Chen PP, Junk AK, Nouri-Mahdavi K, Chen TC. Laser Peripheral Iridotomy in Primary Angle Closure: A Report by the American Academy of Ophthalmology. Ophthalmology. 2018;125:1110–20.
46. Boey PY, Singhal S, Perera SA, Aung T. Conventional and emerging treatments in the management of acute primary angle closure. Clin Ophthalmol. 2012;6:417–24.
Authors
Rahmasari, A. Z., Nurwasis, Wahyuni, I. ., & Djuari, L. . (2022). Comparison of Intraocular Pressure After Phacoemulsification Compared to Laser Peripheral Iridotomy (LPI) in Acute Primary Angle Closure (APAC) Patients: A Systematic Review. Journal of Current Medical Research and Opinion, 5(12), 1510–1519. https://doi.org/10.52845/CMRO/2022/5-12-3
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