Retrospective case series on the long-term visual and intraocular pressure outcomes of phacomorphic glaucoma

PurposeTo analyse the long-term visual acuity (VA) and intraocular pressure (IOP) outcomes in phacomorphic glaucoma.Patients and methodsA retrospective analysis of 100 consecutive, acute phacomorphic glaucoma cases from January 2000 to April 2009 was conducted at The Caritas Medical Centre in Hong Kong. All cases underwent cataract extraction after IOP control with medication andor laser.ResultsDuring a 3.1±2.6-year follow-up, the mean visual improvement was 1.1±0.9 LogMAR units with improvements in 81.7 of cases. A shorter duration from symptoms to cataract extraction resulted in greater visual improvement (r2=0.1, P=0.001). In all, 80.5 of the cases had IOP21mmHg without any glaucoma treatment; 19.5 required 1.6±0.7 glaucoma eye drops; and 3.7 required additional laser iridotomy or trabeculectomy for IOP control at 1.8±2.3 years. The vertical cup-disc ratio (VCDR) of the index eye was 0.6±0.3. Gonioscopy revealed an averaged Shaffer grading of 3.0±1.0 and 99±90 degrees of peripheral anterior synechiae (PAS). The Humphrey automated perimetry mean deviation was 5.2±2.7 and the pattern standard deviation was 15.9±10.ConclusionOver 80 of phacomorphic patients had long-term visual improvements and normalization of IOP after cataract extraction. A shorter attack seemed to offer better VA. Post-operatively, most have open angles with some degree of PAS formation, and glaucomatous optic neuropathy is evident from enlarged VCDRs and visual field defects. At least 2 years of follow-up is useful to detect a 20 glaucoma progression possibly requiring additional glaucoma treatments. © 2010 Macmillan Publishers Limited. All rights reserved.link_to_subscribed_fulltex

Immediate argon laser peripheral iridoplasty (ALPI) as initial treatment for acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction: A preliminary study

Purpose: To study the safety and efficacy of immediate argon laser peripheral iridoplasty (ALPI) as initial treatment of acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction. Methods: In all, 10 consecutive patients with acute phacomorphic angle-closure and intraocular pressure (IOP) ≥40 mmHg were recruited into the study. Each patient received topical atropine (1%) and timolol (0.5%), and immediate ALPI as initial treatment The IOP at 15, 30, 60, and 120 min, and then 1 day, after ALPI were documented by applanation tonometry. Systemic IOP-lowering drugs were only started if IOP remained above 40 mmHg at 2 h after ALPI. Cataract extraction was subsequently performed as definitive treatment. Results: In total, 10 patients (five male, five female), with a mean age ± SD of 73.1 ± 10.3 years were recruited. Mean duration of symptomatic attack was 128 ± 232 h. After ALPI, the mean IOP was reduced from 56.1 ± 12.5 to 45.3 ± 14.5 mmHg at 15 min, 37.6 ± 7.5 mmHg at 30 min, 34.2 ± 9.7 mmHg at 60 min, 25.5 ± 8.7 mmHg at 120 min, and 13.6 ± 4.2 mmHg at 1 day. In one patient, systemic acetazolamide was administered, because the IOP remained above 40 mmHg at 2 h after ALPI. All 10 patients had uncomplicated cataract extraction performed within 4 days after ALPI. No complications from the laser procedure were encountered. Conclusion: Immediate ALPI, replacing systemic antiglaucomatous medications, appeared to be safe and effective as first-line treatment of acute phacomorphic angle-closure. © 2005 Nature Publishing Group All rights reserved.link_to_subscribed_fulltex