Surgical management of closed angle glaucoma: our experience

Abstract

In this paper we present our experience of the last three years in the surgical treatment of eyes with closed angle glaucoma. We have performed an extracapsular lens extraction and posterior chamber intraocular lens implantation on 34 eyes of 34 patients. All of them were affected by closed angle glaucoma with variable control after a Yag laser iridotomy: 6 eyes had high I.O.P. notwithstanding maximal therapy, 11 eyes had I.O.P. under control (less than 21 mmHg) without therapy, 9 with I.O.P. controlled with topical therapy, 8 with I.O.P. controlled with maximal therapy (C.A.I, included).

The cases with well controlled glaucoma were operated on because of the presence of a more or less significant lens opacities. After a follow-up of up to 40 months (mean=20.3, range=1–40), all eyes show satisfactory intraocular pressure and no eye needed a filtering procedure. The results of our studies are as follows (values are mean±SD). In the group of 6 eyes with high I.O.P., the mean pre-operative intraocular pressure was 29.7±5.6 mmHg and the mean post-operative I.O.P. was 15.1±1.4mmHg. The mean reduction was 14.5±6.6mmHg (p<0.005). In the 28 eyes with pre-operative I.O.P. under control (17.5±1.6), the mean post-operative I.O.P. was 14.4±2.3 mmHg, with a mean reduction of 3.1±3.1 mmHg (p< 0.005). Before the E.C.C.E., 11 eyes had I.O.P. less than 21 mmHg without anti-glaucoma medication, whereas after the E.C.C.E. 28 eyes did not need such a medication. No significant correlation was found between pre-operative and post-operative extension of peripheral anterior synechiae (when assessable) and post-operative intraocular pressure control. The difference between pre- and post-operative anterior chamber depth measured by ultrasonic biometry was remarkable, i.e. M=1.93+0.36mm and 3.42±0.2mm (pre-operative and post-operative, respectively; p<0.005).