Outcomes of Filtering Surgery Versus Clear Lens Extraction in Young Patients With Angle-Closure Glaucoma.
Li Mengwei, Zhu Wenqing, Fan Xintong, Sun Xinghuai, Kong Xiangmei
AI Summary
For young patients with uncontrolled angle-closure glaucoma, clear lens extraction offers comparable efficacy to filtering surgery for IOP reduction, but with a better safety profile, especially in those with retinal diseases.
Abstract
Purpose
To compare the effect of filtering surgery versus clear lens extraction in young patients with medically uncontrolled angle-closure glaucoma (ACG).
Design
Retrospective, nonrandomized, comparative, interventional study.
Methods
We reviewed the medical charts of patients with the following scenarios: (1) age ≤40 years; (2) diagnosis of ACG without cataract, including primary angle-closure glaucoma (PACG), nanophthalmic ACG, and ACG combined with retinal dystrophies; and (3) ACG undergoing filtering surgery or clear lens extraction. The main outcomes including intraocular pressure (IOP), number of medications, best-corrected visual acuity, and severe complications were extracted at the postoperative early (within 1 week) and late stage (>3 months) follow-up.
Results
Data from 160 eyes of 130 young patients with ACG were available. Eyes with 76 PACG, 12 nanophthalmic ACG, and 26 ACG with retinal diseases underwent filtering surgery, whereas eyes with 22 PACG, 12 nanophthalmic ACG, and 12 ACG with retinal diseases received clear lens extraction. Overall, filtering surgery and clear lens extraction resulted in significant but comparable IOP and drug reductions at the postoperative late stage in each ACG subgroup, with similar complete success rates between 2 treatments (all P > .05). Regarding the safety, filtering surgery and patients with retinal diseases were independent factors associated with postoperative malignant glaucoma (P < .05 in both multivariable logistic regression models).
Conclusions
This study highlights that the efficacy of clear lens extraction is comparable to that of filtering surgery in medically uncontrolled ACG in young patients, but clear lens extraction is safer, especially for young patients with ACG comorbid with retinal diseases.
MeSH Terms
Shields Classification
Key Concepts3
In young patients (age ≤40 years) with medically uncontrolled angle-closure glaucoma (ACG) without cataract, filtering surgery and clear lens extraction resulted in significant but comparable intraocular pressure (IOP) and drug reductions at the postoperative late stage (>3 months) in each ACG subgroup, with similar complete success rates between the two treatments (all P > .05).
In young patients (age ≤40 years) with medically uncontrolled angle-closure glaucoma (ACG) without cataract, clear lens extraction is safer than filtering surgery, especially for young patients with ACG comorbid with retinal diseases.
In young patients (age ≤40 years) with medically uncontrolled angle-closure glaucoma (ACG) without cataract, filtering surgery and patients with retinal diseases were independent factors associated with postoperative malignant glaucoma (P < .05 in both multivariable logistic regression models).
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