EXTRACAPSULAR CATARACT-EXTRACTION WITH POSTERIOR CHAMBER LENS IMPLANTATION IN PRIMARY ANGLE-CLOSURE GLAUCOMA

Purpose: To evaluate long-term intraocular pressure (IOP) control afte r extracapsular cataract extraction (ECCE) with posterior chamber intr aocular lens (IOL) implantation in patients with primary angle-closure glaucoma. Setting: Ophthalmology Department, Groote Schuur Hospital, Cape Town, South Africa. Methods: This retrospective study comprised 1 7 patients (19 eyes) with primary angle-closure glaucoma who had ECCE and posterior chamber IOL implantation. Four presented initially with acute glaucoma, 5 with subacute angle-closure glaucoma, and 8 (10 eyes ) with chronic angle-closure glaucoma. In all, less than half the circ umference of the angle was permanently closed. The drainage angle was evaluated preoperatively and postoperatively to monitor changes in the amount of angle closure. Intraocular pressure was measured in the ear ly and late postoperative periods. Results: On the first postoperative day, mean IOP was 17.2 mm Hg, although 5 patients (26%) had an IOP ri se above 21 mm Hg despite the use of perioperative topical pilocarpine gel. After a mean follow-up of 19 months, IOP remained below 22 mm Hg without medication in 13 eyes (68%) and with topical medication in 5 eyes (26%). Mean number of glaucoma medications was reduced from 1.5/e ye preoperatively to 0.5/eye postoperatively. Conclusion: Cataract ext raction with IOL implantation resulted in good long-term IOP control i n patients with primary angle-closure glaucoma, suggesting that combin ed cataract and trabeculectomy surgery may not be necessary to achieve long-term IOP control in these patients.