Purpose: To assess intraocular pressure changes after phacoemulsification and its correlation with various intra ocular parameters in angle closure patients

Materials and Methods: We studied correlation of various ocular parameters with angle closure and change in intraocular pressure following phacoemulsification in patients aged 55-95 years with IOP>22 mm Hg on 2 or more occasions with angle closure on gonioscopy and cataract

Results: There were 35 angle-closure patients with cataract. Mean age was 73.37±7.42 years out of which 37.15% were male and 62.85% were females, ,60% had myopia, we found a negative correlation with anterior chamber depth (r=-0.468). We also found a positive correlation with, central corneal thickness (r=0.259) and lens thickness (r=0.064) Pre operative mean IOP was 27.60±6.03 while post operatively at 1 week, 2 week, 4 week,6 weeks,3 months was 13.69±2.88,12.23±2.70,12.56±2.51,12.11±2.42 at and 12.40±2.74 respectively .Pre operative gonioscopy scoring was 2.63±1.416 while post operatively at 6 weeks and 3 months was 13.29±1.545 and 13.71±1.416 respectively. Only one patient required antiglaucoma medications post operatively.

Conclusion: Phacoemulsification cataract surgery leads to significant decrease in IOP and increase in ACD in cataract patients with angle closure with peripheral anterior synechiae <180 degrees. Thick crystalline lens leads to angle closure through reduction of ACD and narrowing of angle. Thus cataract surgery may be a safe alternative to glaucoma surgery in angle closure patients and could shift the surgeon’s approach in treatment of concurrent cataract and glaucoma.

Keywords: Cataract Surgery, Phacoemulsification, Intraocular Pressure, Angle Closure.

1. Quigley H.A., Broman A.T. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90:262–267
2. Aung T., Ang L.P., Chan S.-P., Chew P.T. Acute primary angle-closure: long-term intraocular pressure outcome in Asian eyes. Am J Ophthalmol. 2001;131:7–12.
3. George R., Paul P., Baskaran M. Ocular biometry in occludable angles and angle closure glaucoma: a population based survey. Br J Ophthalmol. 2003;87:399–402.
4. Foroozan R, Levkovitch-Verbin H, Habot-Wilner Z, Burla N. Cataract Surgery and Intraocular Pressure. Ophthalmology 2008;115:104-8.
5. Hodge WG, Whitcher JP, Satariano W. Risk factors for agerelated cataracts. Epidemiol Rev 1995;17:336-46.
6. Ughade SN, Zodpey SP, Khanolkar VA. Risk factors for cataract: a case control study. Indian J Ophthalmol 1998;46:221-7.
7. Bobrow JC. Factors Influencing Cataract Formation After Nd: YAG Laser Peripheral Iridotomy. Trans Am Ophthalmol Soc 2008;106:93-7.
8. Kass MA, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, et al. The Ocular Hypertension Treatment Study a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol 2002;120: 701-13.
9. Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M, et al. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol 2002;120:1268-79.146.
10. Sakai H, Sato T, Koibuchi H, Hayakawa K,Yamakawa R &Nagataki S. Anteriorchamber dimensions in patients with angle-closure glaucoma measured by an anterior eyesegment analysis system. Nihon Ganka Gak-kai Zasshi 1996;100: 546–550
11. Quigley HA & Broman AT. The number ofpeople with glaucoma worldwide in 2010 and2020. Br J Ophthalmol 2006;90: 262–267.
12. Shah S, Chatterjee A, Mathai M, Kelly SP, Kwartz J, Henson D, et al. Relationship between corneal thickness and measured intraocular pressure in a general ophthalmology clinic. 1999;106:2154–2160
13. Tomlinson A and Leighton DA. Ocular dimensions and the heredity of angle-closure glaucoma. Br J Ophthal¬mol. 57:475-486, 1973.
14. Saxena S, Agrawal P K, Pratap V B, Nath R. Anterior chamber depth and lens thickness in primary angle-closure glaucoma : A case-control study. Indian J Ophthalmol 1993;41:71-3
15. Angle Closure Glaucoma Three and Five Year Changes in Intraocular Pressures After Clear Corneal Phacoemulsification in Open Angle Glaucoma Patients, Glaucoma Suspects, and Normal Patients Bradford Shingleton;James Pasternack; James Hung; Mark O'Donoghue;
16. Lai, Jimmy &Tham, Clement & Chan, Jonathan. (2006). The Clinical Outcomes of Cataract Extraction by Phacoemulsification in Eyes With Primary Angle-Closure Glaucoma (PACG) and Co-Existing Cataract. Journal of glaucoma. 15. 47-52. 10.1097/01.ijg.0000196619.34368.0a.
17. Shan C. Lin, Marisse Masis, Travis C. Porco, Louis R. Pasquale Trans Am Ophthalmol Soc. 2017 Aug; 115: T6. Published online 2017 Oct 23.Refractive Surgery. J Cataract Refract Surg 2013; 39:673–679; erratum, 971
18. Nolan W Lens extraction in primary angle closure.British journal of ophthalmology 2006:90;1
19. Khokhar S, Sindhu N, Pangtey MS Phacoemulsification in filtered chronic angle closure eyes Clinical & Experimental ophthalmology 2002;30;256-260

Dr Awani Dubey

Resident Doctor, Department of Ophthalmology, Mahatma Gandhi Memorial Medical College, M.Y. Hospital Indore (M.P.) 452001