Long-term outcome after cataract extraction in patients with an attack of acute phacomorphic angle closure

Abstract

Background: Phacomorphic glaucoma arises due to acute angle closure precipitated by sudden hydration of a cataractous lens, which blocks the angle by forward displacement of the iris. During an acute attack, the intraocular pressure is markedly elevated. The initial treatment is aimed at lowering the intraocular pressure followed by definitive treatment in the form of removal of the cataractous lens. We aimed to determine long-term outcome after cataract extraction in patients with acute phacomorphic angle closure. Methods: Fifty-nine eyes of 59 consecutive patients with acute phacomorphic angle closure presenting from June 1998 to December 2008 were included. Patients were treated for initial intraocular pressure reduction followed by cataract extraction and intraocular lens implantation. The presenting features, initial treatment instituted, duration of attack, subsequent visual outcome, intraocular pressure, gonioscopic findings, and optic disc status were reviewed and analysed from patient medical records. Results: The mean patient age was 78.6 (standard deviation, 7.7) years and the mean follow-up period was 58.5 (standard deviation, 36.9) months. The mean presenting intraocular pressure was 56.0 (standard deviation, 11.4) mm Hg, which was successfully controlled with medications or argon laser peripheral iridoplasty. Cataract extraction with intraocular lens implantation was performed in all eyes 1 to 11 days after remission of the acute attack. All eyes had intraocular pressure of <21 mm Hg without medication in the immediate post–cataract extraction period. Gonioscopic findings showed peripheral anterior synechial angle closure of >180° in 16 eyes (27.1%). Ten (16.9%) of the 59 eyes subsequently developed an increase in intraocular pressure of >21 mm Hg, for which medical treatment was given. Final visual acuity improved in 74.6% of the eyes. A more extensive peripheral anterior synechial angle closure was associated with a longer duration of acute attack, but not the method of cataract extraction or the method of initial intraocular pressure control. Conclusions: In acute phacomorphic angle closure, rapid reduction of intraocular pressure and control of inflammation followed by extracapsular cataract extraction or phacoemulsification is associated with favorable long-term visual outcomes.