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Effects of lens extraction versus laser peripheral iridotomy on anterior segment morphology in primary angle closure suspect

  • Glaucoma
  • Published:
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Abstract

Purpose

To compare the anatomical effects on anterior segment by lens extraction (LE, phacoemulsification with posterior chamber intraocular lens implantation) and laser peripheral iridotomy (LPI) in primary angle closure suspect (PACS) eyes.

Methods

This prospective comparative cohort trial included a total of 122 consecutive patients identified as PACS aged 52 to 80 years. LE or LPI was performed based on each patient’s choice. The anterior segment optical coherence tomography (ASOCT) and gonioscopy were conducted at baseline and 4 weeks post-operation. Outcome measures include percentage of residual angle closure, mean angle width (modified Shaffer grade), angle opening distance (AOD), trabecular iris angle (TIA), trabecular iris space area (TISA), anterior chamber depth (ACD), iris curvature (I-Curve), lens vault (LV), intraocular pressure (IOP), and best-corrected visual acuity (BCVA).

Results

All anterior angle parameters (AOD, TIA, and TISA) were significantly greater after LE than LPI (P < 0.001 for all). ACD (P < 0.001) increased, LV (P < 0.001) decreased, IOP (P < 0.001) decreased, and BCVA (P < 0.001) increased after LE. However, no significant changes were found in ACD (P = 0.782), LV (P = 0.616), IOP (P = 0.112), and BCVA (P = 0.131) after LPI. In both groups, I-Curve decreased after the operation, but the iris was flatter after LE than LPI (P < 0.001). Gonioscopically, the LE group achieved a larger post-operative angle width (modified Shaffer grade) than LPI (P < 0.001) and all anterior chamber angles were open (defined as posterior pigmented trabecular meshwork (PTM) visible with static gonioscopy) after operation. Nevertheless, after LPI, 12 eyes (20.0%) still had two or more quadrants and 32 eyes (53.3%) still had at least one quadrant in which the posterior PTM could not be observed.

Conclusions

Compared with LPI, LE resulted in a wider anterior chamber angle, a deeper anterior chamber, and a lower IOP in PACS eyes. Moreover, no residual angle closure was observed after LE, which could morphologically prevent the progress of angle closure.

Trial registration

ChiCTR1800016511

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References

  1. Quigley HA, Broman AT (2006) The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 90(3):262–267. https://doi.org/10.1136/bjo.2005.081224

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Prum BE Jr, Herndon LW Jr, Moroi SE, Mansberger SL, Stein JD, Lim MC, Rosenberg LF, Gedde SJ, Williams RD (2016) Primary angle closure preferred practice pattern((R)) guidelines. Ophthalmology 123(1):P1–P40. https://doi.org/10.1016/j.ophtha.2015.10.049

    Article  PubMed  Google Scholar 

  3. He M, Foster PJ, Ge J, Huang W, Zheng Y, Friedman DS, Lee PS, Khaw PT (2006) Prevalence and clinical characteristics of glaucoma in adult Chinese: a population-based study in Liwan District, Guangzhou. Invest Ophthalmol Vis Sci 47(7):2782–2788. https://doi.org/10.1167/iovs.06-0051

    Article  PubMed  Google Scholar 

  4. Foster PJ, Oen FT, Machin D, Ng TP, Devereux JG, Johnson GJ, Khaw PT, Seah SK (2000) The prevalence of glaucoma in Chinese residents of Singapore: a cross-sectional population survey of the Tanjong Pagar district. Arch Ophthalmol 118(8):1105–1111

    Article  CAS  PubMed  Google Scholar 

  5. Foster PJ, Johnson GJ (2001) Glaucoma in China: how big is the problem? Br J Ophthalmol 85(11):1277–1282

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Liang Y, Friedman DS, Zhou Q, Yang XH, Sun LP, Guo L, Chang DS, Lian L, Wang NL, Handan Eye Study G (2011) Prevalence and characteristics of primary angle-closure diseases in a rural adult Chinese population: the Handan Eye Study. Invest Ophthalmol Vis Sci 52(12):8672–8679. https://doi.org/10.1167/iovs.11-7480

    Article  PubMed  Google Scholar 

  7. American Academy of Ophthalmology (1994) Laser peripheral iridotomy for pupillary-block glaucoma. Ophthalmology 101(10):1749–1758

    Article  Google Scholar 

  8. Robin AL, Pollack IP (1982) Argon laser peripheral iridotomies in the treatment of primary angle closure glaucoma. Long-term follow-up. Arch Ophthalmol 100(6):919–923

    Article  CAS  PubMed  Google Scholar 

  9. Caronia RM, Liebmann JM, Stegman Z, Sokol J, Ritch R (1996) Increase in iris-lens contact after laser iridotomy for pupillary block angle closure. Am J Ophthalmol 122(1):53–57

    Article  CAS  PubMed  Google Scholar 

  10. Saunders DC (1990) Acute closed-angle glaucoma and Nd-YAG laser iridotomy. Br J Ophthalmol 74(9):523–525

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. How AC, Baskaran M, Kumar RS, He M, Foster PJ, Lavanya R, Wong HT, Chew PT, Friedman DS, Aung T (2012) Changes in anterior segment morphology after laser peripheral iridotomy: an anterior segment optical coherence tomography study. Ophthalmology 119(7):1383–1387. https://doi.org/10.1016/j.ophtha.2012.01.019

    Article  PubMed  Google Scholar 

  12. He M, Friedman DS, Ge J, Huang W, Jin C, Cai X, Khaw PT, Foster PJ (2007) Laser peripheral iridotomy in eyes with narrow drainage angles: ultrasound biomicroscopy outcomes. The Liwan Eye Study. Ophthalmology 114(8):1513–1519. https://doi.org/10.1016/j.ophtha.2006.11.032

    Article  PubMed  Google Scholar 

  13. Zebardast N, Kavitha S, Krishnamurthy P, Friedman DS, Nongpiur ME, Aung T, Quigley HA, Ramulu PY, Venkatesh R (2016) Changes in anterior segment morphology and predictors of angle widening after laser iridotomy in south Indian eyes. Ophthalmology 123(12):2519–2526. https://doi.org/10.1016/j.ophtha.2016.08.020

    Article  PubMed  Google Scholar 

  14. Baskaran M, Yang E, Trikha S, Kumar RS, Wong HT, He M, Chew PTK, Foster PJ, Friedman D, Aung T (2017) Residual angle closure one year after laser peripheral iridotomy in primary angle closure suspects. Am J Ophthalmol 183:111–117. https://doi.org/10.1016/j.ajo.2017.08.016

    Article  PubMed  Google Scholar 

  15. Ang LP, Aung T, Chew PT (2000) Acute primary angle closure in an Asian population: long-term outcome of the fellow eye after prophylactic laser peripheral iridotomy. Ophthalmology 107(11):2092–2096

    Article  CAS  PubMed  Google Scholar 

  16. Alsagoff Z, Aung T, Ang LP, Chew PT (2000) Long-term clinical course of primary angle-closure glaucoma in an Asian population. Ophthalmology 107(12):2300–2304

    Article  CAS  PubMed  Google Scholar 

  17. Peng PH, Nguyen H, Lin HS, Nguyen N, Lin S (2011) Long-term outcomes of laser iridotomy in Vietnamese patients with primary angle closure. Br J Ophthalmol 95(9):1207–1211. https://doi.org/10.1136/bjo.2010.181016

    Article  PubMed  Google Scholar 

  18. Choi JS, Kim YY (2005) Progression of peripheral anterior synechiae after laser iridotomy. Am J Ophthalmol 140(6):1125–1127. https://doi.org/10.1016/j.ajo.2005.06.018

    Article  PubMed  Google Scholar 

  19. Sihota R, Rao A, Gupta V, Srinivasan G, Sharma A (2010) Progression in primary angle closure eyes. J Glaucoma 19(9):632–636. https://doi.org/10.1097/IJG.0b013e3181ca7de9

    Article  PubMed  Google Scholar 

  20. Weinreb RN, Aung T, Medeiros FA (2014) The pathophysiology and treatment of glaucoma: a review. Jama 311(18):1901–1911. https://doi.org/10.1001/jama.2014.3192

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Hayashi K, Hayashi H, Nakao F, Hayashi F (2001) Effect of cataract surgery on intraocular pressure control in glaucoma patients. J Cataract Refract Surg 27(11):1779–1786

    Article  CAS  PubMed  Google Scholar 

  22. Lai JS, Tham CC, Chan JC (2006) The clinical outcomes of cataract extraction by phacoemulsification in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract: a prospective case series. J Glaucoma 15(1):47–52

    Article  PubMed  Google Scholar 

  23. Thomas R, George R, Parikh R, Muliyil J, Jacob A (2003) Five year risk of progression of primary angle closure suspects to primary angle closure: a population based study. Br J Ophthalmol 87(4):450–454

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Lowe RF (1969) Causes of shallow anterior chamber in primary angle-closure glaucoma. Ultrasonic biometry of normal and angle-closure glaucoma eyes. Am J Ophthalmol 67(1):87–93

    Article  CAS  PubMed  Google Scholar 

  25. Lowe RF (1970) Aetiology of the anatomical basis for primary angle-closure glaucoma. Biometrical comparisons between normal eyes and eyes with primary angle-closure glaucoma. Br J Ophthalmol 54(3):161–169

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Memarzadeh F, Tang M, Li Y, Chopra V, Francis BA, Huang D (2007) Optical coherence tomography assessment of angle anatomy changes after cataract surgery. Am J Ophthalmol 144(3):464–465. https://doi.org/10.1016/j.ajo.2007.04.009

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wang N, Wu H, Fan Z (2002) Primary angle closure glaucoma in Chinese and Western populations. Chin Med J 115(11):1706–1715

    PubMed  Google Scholar 

  28. Azuara-Blanco A, Burr J, Ramsay C, Cooper D, Foster PJ, Friedman DS, Scotland G, Javanbakht M, Cochrane C, Norrie J, group Es (2016) Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet 388(10052):1389–1397. https://doi.org/10.1016/S0140-6736(16)30956-4

    Article  PubMed  Google Scholar 

  29. Karpecki PM (2015) Kanski’s clinical ophthalmology: a systematic approach, 8th edition. Optom Vis Sci 92(10):e386–e386. https://doi.org/10.1097/Opx.0000000000000737

    Article  Google Scholar 

  30. Radhakrishnan S, Goldsmith J, Huang D, Westphal V, Dueker DK, Rollins AM, Izatt JA, Smith SD (2005) Comparison of optical coherence tomography and ultrasound biomicroscopy for detection of narrow anterior chamber angles. Arch Ophthalmol 123(8):1053–1059. https://doi.org/10.1001/archopht.123.8.1053

    Article  PubMed  Google Scholar 

  31. Sng CC, Allen JC, Nongpiur ME, Foo LL, Zheng Y, Cheung CY, He M, Friedman DS, Wong TY, Aung T (2013) Associations of iris structural measurements in a Chinese population: the Singapore Chinese Eye Study. Invest Ophthalmol Vis Sci 54(4):2829–2835. https://doi.org/10.1167/iovs.12-11250

    Article  PubMed  Google Scholar 

  32. Nongpiur ME, He M, Amerasinghe N, Friedman DS, Tay WT, Baskaran M, Smith SD, Wong TY, Aung T (2011) Lens vault, thickness, and position in Chinese subjects with angle closure. Ophthalmology 118(3):474–479. https://doi.org/10.1016/j.ophtha.2010.07.025

    Article  PubMed  Google Scholar 

  33. Lee RY, Kasuga T, Cui QN, Huang G, He M, Lin SC (2013) Association between baseline angle width and induced angle opening following prophylactic laser peripheral iridotomy. Invest Ophthalmol Vis Sci 54(5):3763–3770. https://doi.org/10.1167/iovs.13-11597

    Article  PubMed  PubMed Central  Google Scholar 

  34. Lee KS, Sung KR, Shon K, Sun JH, Lee JR (2013) Longitudinal changes in anterior segment parameters after laser peripheral iridotomy assessed by anterior segment optical coherence tomography. Invest Ophthalmol Vis Sci 54(5):3166–3170. https://doi.org/10.1167/iovs.13-11630

    Article  PubMed  Google Scholar 

  35. Huang G, Gonzalez E, Lee R, Osmonavic S, Leeungurasatien T, He M, Lin SC (2012) Anatomic predictors for anterior chamber angle opening after laser peripheral iridotomy in narrow angle eyes. Curr Eye Res 37(7):575–582. https://doi.org/10.3109/02713683.2012.655396

    Article  PubMed  Google Scholar 

  36. Jiang Y, Chang DS, Zhu H, Khawaja AP, Aung T, Huang S, Chen Q, Munoz B, Grossi CM, He M, Friedman DS, Foster PJ (2014) Longitudinal changes of angle configuration in primary angle-closure suspects: the Zhongshan Angle-Closure Prevention Trial. Ophthalmology 121(9):1699–1705. https://doi.org/10.1016/j.ophtha.2014.03.039

    Article  PubMed  Google Scholar 

  37. Man X, Chan NC, Baig N, Kwong YY, Leung DY, Li FC, Tham CC (2015) Anatomical effects of clear lens extraction by phacoemulsification versus trabeculectomy on anterior chamber drainage angle in primary angle-closure glaucoma (PACG) patients. Graefe’s archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle. Ophthalmologie 253(5):773–778. https://doi.org/10.1007/s00417-015-2936-z

    Article  Google Scholar 

  38. Hayashi K, Hayashi H, Nakao F, Hayashi F (2000) Changes in anterior chamber angle width and depth after intraocular lens implantation in eyes with glaucoma. Ophthalmology 107(4):698–703

    Article  CAS  PubMed  Google Scholar 

  39. Nonaka A, Kondo T, Kikuchi M, Yamashiro K, Fujihara M, Iwawaki T, Yamamoto K, Kurimoto Y (2005) Cataract surgery for residual angle closure after peripheral laser iridotomy. Ophthalmology 112(6):974–979. https://doi.org/10.1016/j.ophtha.2004.12.042

    Article  PubMed  Google Scholar 

  40. He M, Friedman DS, Ge J, Huang W, Jin C, Lee PS, Khaw PT, Foster PJ (2007) Laser peripheral iridotomy in primary angle-closure suspects: biometric and gonioscopic outcomes: the Liwan Eye Study. Ophthalmology 114(3):494–500. https://doi.org/10.1016/j.ophtha.2006.06.053

    Article  PubMed  Google Scholar 

  41. Lee KS, Sung KR, Kang SY, Cho JW, Kim DY, Kook MS (2011) Residual anterior chamber angle closure in narrow-angle eyes following laser peripheral iridotomy: anterior segment optical coherence tomography quantitative study. Jpn J Ophthalmol 55(3):213–219. https://doi.org/10.1007/s10384-011-0009-3

    Article  PubMed  Google Scholar 

  42. Tham CC, Leung DY, Kwong YY, Li FC, Lai JS, Lam DS (2010) Effects of phacoemulsification versus combined phaco-trabeculectomy on drainage angle status in primary angle closure glaucoma (PACG). J Glaucoma 19(2):119–123. https://doi.org/10.1097/IJG.0b013e31819d5d0c

    Article  PubMed  Google Scholar 

  43. Lee RY, Kasuga T, Cui QN, Porco TC, Huang G, He M, Lin SC (2014) Association between baseline iris thickness and prophylactic laser peripheral iridotomy outcomes in primary angle-closure suspects. Ophthalmology 121(6):1194–1202. https://doi.org/10.1016/j.ophtha.2013.12.027

    Article  PubMed  Google Scholar 

  44. Moghimi S, Bijani F, Chen R, Yasseri M, He M, Lin SC, Weinreb RN (2018) Anterior segment dimensions following laser iridotomy in acute primary angle closure and fellow eyes. Am J Ophthalmol 186:59–68. https://doi.org/10.1016/j.ajo.2017.11.013

    Article  PubMed  Google Scholar 

  45. Guzman CP, Gong T, Nongpiur ME, Perera SA, How AC, Lee HK, Cheng L, He M, Baskaran M, Aung T (2013) Anterior segment optical coherence tomography parameters in subtypes of primary angle closure. Invest Ophthalmol Vis Sci 54(8):5281–5286. https://doi.org/10.1167/iovs.13-12285

    Article  PubMed  Google Scholar 

  46. Sng CCA, Aquino MCD, Liao J, Ang M, Zheng C, Loon SC, Chew PTK (2014) Pretreatment anterior segment imaging during acute primary angle closure: insights into angle closure mechanisms in the acute phase. Ophthalmology 121(1):119–125. https://doi.org/10.1016/j.ophtha.2013.08.004

    Article  PubMed  Google Scholar 

  47. Yang HS, Lee J, Choi S (2013) Ocular biometric parameters associated with intraocular pressure reduction after cataract surgery in normal eyes. Am J Ophthalmol 156(1):89–94 e81. https://doi.org/10.1016/j.ajo.2013.02.003

    Article  PubMed  Google Scholar 

  48. Mansberger SL, Gordon MO, Jampel H, Bhorade A, Brandt JD, Wilson B, Kass MA, Ocular Hypertension Treatment Study G (2012) Reduction in intraocular pressure after cataract extraction: the Ocular Hypertension Treatment Study. Ophthalmology 119(9):1826–1831. https://doi.org/10.1016/j.ophtha.2012.02.050

    Article  PubMed  Google Scholar 

  49. Shams PN, Foster PJ (2012) Clinical outcomes after lens extraction for visually significant cataract in eyes with primary angle closure. J Glaucoma 21(8):545–550. https://doi.org/10.1097/IJG.0b013e31821db1db

    Article  PubMed  Google Scholar 

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Funding

This work was supported by the National Natural Science Foundation of China (81600716) and the Zhejiang Province Key Research and Development Program of China (2015C03042).

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Authors and Affiliations

  1. Eye Center of the 2nd Affiliated Hospital, Medical College of Zhejiang University, Number 88 Jiefang Road, Hangzhou, China

    Chenxi Yan, Yibo Yu, Wei Wang, Danni Lyu, Yizhen Tang & Ke Yao

  2. Department of Ophthalmology, University of California, San Francisco, CA, USA

    Ying Han

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  1. Chenxi Yan
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  2. Ying Han
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  3. Yibo Yu
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  4. Wei Wang
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  7. Ke Yao
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Corresponding author

Correspondence to Ke Yao.

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This prospective study was approved by the ethics committee of the Institutional Review Board of the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Yan, C., Han, Y., Yu, Y. et al. Effects of lens extraction versus laser peripheral iridotomy on anterior segment morphology in primary angle closure suspect. Graefes Arch Clin Exp Ophthalmol 257, 1473–1480 (2019). https://doi.org/10.1007/s00417-019-04353-8

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  • DOI: https://doi.org/10.1007/s00417-019-04353-8

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