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Lens Extraction in Angle Closure Glaucoma

  • Chapter
Advanced Glaucoma Surgery

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

  • 995 Accesses

Abstract

Primary angle closure glaucoma (PACG) represents a significant burden to glaucoma services throughout the world, accounting for 26 % of all people with glaucoma. Furthermore, it is estimated that angle closure glaucoma accounts for 50 % of total glaucoma blindness. Whilst traditional management involves the use of topical intraocular pressure (IOP) lowering medications and laser treatment in the form of iridotomy or iridoplasty, in many cases this is suboptimal—glaucoma continues to progress and lead to irreversible sight loss.

Lens extraction is increasingly being recognized as an effective treatment option for PACG. Evidence from anterior segment imaging, such as anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) suggests that mechanical factors such as lens vault and thickness likely exacerbate angle crowding. Lens extraction addresses these factors, hypothetically permitting improved aqueous access to the trabecular meshwork. The publication of cohort studies and randomized control trials have provided a strong foundation for ophthalmic surgeons to offer lens extraction surgery as a viable treatment option for PACG, recognizing better IOP control and the reduced need for IOP lowering medications. Furthermore, simultaneous additional procedures at the time of lens extraction, such as goniosynechialysis (GSL) and trabeculectomy, have been advocated to improve IOP control further.

This chapter begins with a summary of the theoretical role of the lens in ACG. The argument for considering lens extraction in PACG is then described, along with aspects of preoperative counselling. Surgical techniques for the management of eyes with coexisting PACG and cataract are expressed from our practice, which have helped to reduce complications and ensure optimal outcomes for patients.

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Acknowledgements

Financial disclosures: Nil.

Statement of informed consent: All imaging was recorded following informed consent from patients involved.

Statement on Conflict of interest: Sameer Trikha, Shamira Perera, Rahat Husain, and Tin Aung declare that they have no conflict of interest.

Ethical statement: No animal or human studies were carried out by the authors for this article. Furthermore, informed Consent and Animal Studies disclosures are not applicable to this review.

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Authors and Affiliations

  1. Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore

    Sameer Trikha B.Sc. (Hons). F.R.C.Ophth., Shamira A. Perera B.Sc. (Hons). F.R.C.Ophth., Rahat Husain M.D. Res., F.R.C.Ophth. & Tin Aung F.R.C.Ophth., Ph.D.

  2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Tin Aung F.R.C.Ophth., Ph.D.

Authors
  1. Sameer Trikha B.Sc. (Hons). F.R.C.Ophth.
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  2. Shamira A. Perera B.Sc. (Hons). F.R.C.Ophth.
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  3. Rahat Husain M.D. Res., F.R.C.Ophth.
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  4. Tin Aung F.R.C.Ophth., Ph.D.
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Corresponding author

Correspondence to Tin Aung F.R.C.Ophth., Ph.D. .

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Editors and Affiliations

  1. Illinois Eye & Ear Infirmary, University of Illinois at Chicago School of Medicine, Chicago, Illinois, USA

    Ahmad A. Aref

  2. Southern California, LA, CA, USA, USC Eye Ins.Dept. of Ophth. Univ.of Southern California, LA, CA, USA, California, California, USA

    Rohit Varma

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Trikha, S., Perera, S.A., Husain, R., Aung, T. (2015). Lens Extraction in Angle Closure Glaucoma. In: Aref, A., Varma, R. (eds) Advanced Glaucoma Surgery. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-18060-1_4

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  • DOI: https://doi.org/10.1007/978-3-319-18060-1_4

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-18059-5

  • Online ISBN: 978-3-319-18060-1

  • eBook Packages: MedicineMedicine (R0)

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