Primary Phacoemulsification and Intraocular Lens Implantation for Acute Primary Angle-Closure

BACKGROUND To investigate the effect of primary phacoemulsification on intraocular pressure (IOP) in patients with acute primary angle-closure (PAC) and coexisting cataract. METHODOLOGY Sixteen eyes of 14 patients with acute PAC received phacoemulsification and intraocular lens implantation as initial management for medically uncontrolled IOP in a retrospective chart review. The effects on IOP, vision, anterior chamber depth (ACD), and number of antiglaucoma medications were evaluated. PRINCIPAL FINDINGS The postoperative IOP was reduced in 16 eyes (100%). The mean ± standard deviation preoperative IOP was 48.81 ± 16.83 mm Hg, which decreased postoperatively to 16.46 ± 10.67 mm Hg at 1 day, 9.43 ± 3.03 mm Hg at 1 week, 9.49 ± 2.14 mm Hg at 2 weeks, 10.78 ± 3.56 mm Hg at 1 month, and 10.70 ± 2.80 mm Hg at 3 months (p < 0.001). The mean number of antiglaucoma medications decreased from 3.56 ± 1.14 to 0.13 ± 0.34 (p < 0.001). The average preoperative ACD was 2.08 ± 0.35 mm, which increased to 3.59 ± 0.33 mm after surgery (p < 0.001). Visual acuity (converted into logarithm of the minimum angle of resolution [logMAR]) improved from 1.14 ± 0.71 to 0.73 ± 0.53 (p =  0.001). CONCLUSIONS Primary phacoemulsification plus intraocular lens implantation lowered IOP, reduced the use of antiglaucoma medications, and improved vision in patients with acute PAC. This is a safe and effective method of IOP control and can be considered a first treatment option in managing patients with acute PAC and coexisting cataract.