Clinical outcome of phacoemulsification combined with intraocular lens implantation for primary angle closure/glaucoma (PAC/PACG) with cataract

Objective: To evaluate the efficacy of phacoemulsification (Phaco) combined with intraocular lens implantation for treatment of primary angle-closure glaucoma (PACG) patients with cataract. Methods: A total of 62 patients treated in our hospital meeting the inclusion criteria were included, including 62 eyes (26 PAC eyes and 36 PACG eyes). PACG patients were divided into early, middle, and advanced stages based on the HPA visual field staging system. The subjects were also grouped according to the extent of peripheral anterior synechia (PAS). Patients received topical medical treatment preoperatively and Phaco performed by the same surgeon. The visual acuity, intraocular pressure (IOP), anterior chamber depth (ACD), medication used, visual field and retinal nerve fiber layer (RNFL) were observed before and 6-24 months after surgery. Results: The mean age of the patients was 68 +/- 8.91 years old, and postoperative follow-up was 13.1 +/- 5.5 months. Postoperative visual acuity was improved in all patients (P<0.001). Postoperatively, the IOP decreased significantly (P<0.001), the number of medications was reduced (P<0.001), and the ACD was deeper than that before operation (P<0.001). There was no significant difference in visual field (P=0.973) or RNFL (P=0.268) after surgery during the follow-up. There was no statistical difference in postoperative changes of various indexes between PAC and PACG patients. The decrease of IOP in patients with early stage PACG was significantly higher than that in patients in the middle and advanced stages (F=3.519, P=0.041), and the number of medications used in early-stage PACG patients was also significantly lower than that of advanced patients (P=0.020). There was no significant difference in postoperative visual acuity (X-2 =0.139, P=0.987) or IOP decline (F=0.260, P=0.854) among patients with different extents of preoperative PAS, nor was there any correlation between postoperative IOP control and preoperative PAS. No serious complications were observed in any subject. Conclusion: In PAC/PACG patients, Phaco can significantly control IOP, and prevent visual field defect and progressive loss of RNFL, indicating that the procedure has a protective effect on the optic nerve. Phaco is more effective in the treatment of early stage PACG than in middle or advanced stage, and can be used in PAC/PACG patients with different extents of PAS, but close follow-up is necessary.