Clear lens extraction for the management of primary angle closure glaucoma: surgical technique and refractive outcomes in the EAGLE cohort

Comparison of intraocular lens power calculation formulas in patients with a history of acute primary angle-closure attack

BACKGROUND

To compare the accuracy of nine intraocular lens (IOL) power calculation formulas, including three traditional formulas (SRK/T, Haigis, and Hoffer Q) and six new-generation formulas (Barrett Universal II [BUII], Hill-Radial Basis Function [RBF] 3.0, Kane, Emmetropia verifying optical [EVO], Ladas Super, and Pearl-DGS) in patients who underwent cataract surgery after acute primary angle closure (APAC).

METHODS

In this retrospective cross-sectional study, 44 eyes of 44 patients (APAC) and 60 eyes of 60 patients (control) were included. We compared the mean absolute error, median absolute error (MedAE), and prediction error after surgery. Subgroup analyses were performed on whether axial length (AL) or preoperative laser peripheral iridotomy affected the postoperative refractive outcomes.

RESULTS

In the APAC group, all formulas showed higher MedAE and more myopic shift than the control group (all P < 0.05). In APAC eyes with AL ≥ 22 mm, there were no differences in MedAEs according to the IOL formulas; however, in APAC eyes with AL < 22 mm, Haigis (0.49 D) showed lower MedAE than SRK/T (0.82 D) (P = 0.036) and Hill-RBF 3.0 (0.54 D) showed lower MedAE than SRK/T (0.82 D), Hoffer Q (0.75 D) or Kane (0.83 D) (P = 0.045, 0.036 and 0.027, respectively). Pearl-DGS (0.63 D) showed lower MedAE than Hoffer Q (0.75 D) and Kane (0.83 D) (P = 0.045 and 0.036, respectively). Haigis and Hill-RBF 3.0 showed the highest percentage (46.7%) of eyes with PE within ± 0.5 D in APAC eyes with AL < 22 mm. Iridectomized eyes did not show superior precision than the non-iridotomized eyes in the APAC group.

CONCLUSIONS

Refractive errors in the APAC group were more myopic than those in the control group. Haigis and Hill-RBF 3.0 showed high precision in the eyes with AL < 22 mm in the APAC group.

The Japan Glaucoma Society guidelines for glaucoma 5th edition

We are pleased to bring you the 5th edition of the Glaucoma Clinical Practice Guidelines. Clinical practice guidelines are based on evidence (scientific grounds). It is a document that presents the treatment that is the most appropriate for the patient. "Glaucoma Clinical Guidelines" was first published in 2003. This was the first guideline for glaucoma treatment in Japan. The principle of glaucoma treatment is to lower intraocular pressure. Means for lowering intraocular pressure includes drugs, lasers, and surgery; Glaucoma is a disease that should be considered as a complex syndrome rather than a single condition. Therefore, the actual medical treatment is not as simple as one word. This time we set the Clinical Questionnaire with a focus on glaucoma treatment. We hope that you will take advantage of the 5th edition.

Recurring themes during cataract assessment and surgery

The aim of this review was to discuss frequently encountered themes such as cataract surgery in presence of age-related macular degeneration (AMD), dementia, Immediate Sequential Bilateral Cataract Surgery (ISBCS), discussing non-standard intraocular lens (IOL) options during consultation in the National Health Services (NHS) and the choice of the biometric formulae based on axial length. Individual groups of authors worked independently on each topic. We found that cataract surgery does improve visual acuity in AMD patients but the need for cataract surgery should be individualised. In patients with dementia, cataract surgery should be considered 'sooner rather than later' as progression may prevent individuals presenting for surgery. This should be planned after discussion of patients' best interests with any carers; multifocal IOLs are not proven to be the best option in these patients. ISBCS gives comparable outcomes to delayed sequential surgeries with a low risk of bilateral endophthalmitis and it can be cost-saving and efficient. Patients are entitled to know all suitable IOL options that can improve their quality of life. Deliberately withholding this information or pressuring patients to choose a non-standard IOL is inappropriate. However, one should be mindful of the not spending inappropriate amounts of time discussing these in the NHS setting which may affect care of other NHS patients. Evidence suggests Hoffer Q, Haigis, Hill-RBF and Kane formulae for shorter eyes; Barrett Universal II (BU II), Holladay II, Haigis and Kane formulae for longer eyes and BU II, Hill-RBF and Kane formulae for medium axial length eyes.

Femtosecond laser-assisted cataract surgery in shallow anterior chamber cases

PURPOSE

To assess the effectiveness, safety and predictability of femtosecond laser-assisted cataract surgery (FLACS) in eyes with shallow anterior chamber (AC).

METHODS

This is a prospective consecutive clinical study. All eyes presented an anterior chamber depth (ACD) ≤ 2.1 mm and were submitted to FLACS with monofocal intraocular lens (mIOL) or trifocal intraocular lens (tIOL) implantation. Uncorrected distance visual acuity (VA) and corrected distance VA values were used to assess efficacy and safety of the surgery. Refraction, intraocular pressure (IOP), endothelial cell density (ECD) and ACD were evaluated before and 6 months post-surgery.

RESULTS

Phacoemulsification was carried out successfully in all eyes, without intra- or postoperative complications. Efficacy and safety indexes were 0.96 and 1.26 for the mIOL group, and 0.87 and 1.01 for the tIOL group, respectively. The mean postoperative spherical equivalent was - 0.06 ± 0.28D and - 0.14 ± 0.38D for the mIOL and tIOL groups, respectively. The ECD varied from 2470 ± 483 to 2009 ± 538 cells/mm² (p < 0.05) and from 2443 ± 319 to 2245 ± 628 cells/mm² (p = 0.06) for the mIOL and tIOL groups, respectively. IOP significantly decreased (p < 0.05) after the surgery from 14.34 to 12.85 mmHg for the mIOL group and from 14.37 to 11.91 mmHg for the tIOL group, with a general reduction of medical hypotensive treatment in both groups (85% of cases required ≤ number of medications). ACD changed significantly (p < 0.05) from 1.96 ± 0.15 mm to 3.75 ± 0.30 mm after the surgery in the mIOL group and from 1.94 ± 0.15 mm to 3.23 ± 0.21 mm for the tIOL group.

CONCLUSION

FLACS with implantation of either mIOL or tIOL may provide good efficacy, safety and predictability in eyes with shallow AC.

Cataract surgery and intraocular pressure in glaucoma

PURPOSE OF REVIEW

To review the current literature on the relationship between cataract extraction and intraocular pressure (IOP).

RECENT FINDINGS

Cataract extraction can be an effective IOP lowering treatment for open and closed angle glaucoma as well as ocular hypertension. In comparative trials studying novel micro-invasive glaucoma surgeries in open angle glaucoma, the control group undergoing cataract extraction alone routinely achieved significant reductions in IOP and medication use postoperatively. Data from the Effectiveness in Angle Closure Glaucoma of Lens Extraction (EAGLE) trials have demonstrated that lens extraction is more effective at lowering IOP than peripheral iridotomy in patients with angle closure and should be considered as first line therapy. Additionally, patients in the ocular hypertension treatment study who underwent cataract extraction over the course of follow-up demonstrated significant IOP lowering sustained over 3 years.

SUMMARY

Cataract extraction is an effective method to lower IOP in patients with glaucoma. Pressure lowering is more significant in eyes with narrow angles and those with higher baseline IOP levels. In eyes with angle closure, phacoemulsification alone can lower IOP, but when combined with GSL it may be even more effective. Recent large multicenter randomized trials have further elucidated the benefit of standalone cataract extraction to treat mild to moderate primary open angle glaucoma. Prospective and longitudinal studies that systematically investigate the variables that may influence degree and duration of IOP lowering post cataract extraction are lacking.