Role of lens extraction and laser peripheral iridotomy in treatment of glaucoma.
Pose-Bazarra Sara, Azuara-Blanco Augusto
AI Summary
This review confirms lens extraction lowers IOP in glaucoma, especially PACG with high pre-op IOP, often outperforming LPI, providing a key treatment option.
Abstract
Purpose of review: Lens extraction in people with coexisting cataract and open angle glaucoma is associated with a reduction in intraocular pressure (IOP). In primary angle-closure glaucoma (PACG), lens extraction and laser peripheral iridotomy (LPI) can be used to open the anterior chamber angle, increase the outflow through the trabecular meshwork and reduce the IOP. The present review will summarize the recent available literature regarding the role of both interventions for the treatment of glaucoma.
Recent findings: Recent articles have confirmed the effect of cataract surgery as an IOP-lowering procedure in people with coexisting cataract and glaucoma, and highlight that the most important predictor for a greater decrease is a higher preoperative IOP. The probability for achieving a significant IOP reduction is highest in PACG and pseudoexfoliation glaucoma. Clear lens extraction (CLE) is associated with better clinical and quality of life outcomes than laser peripheral iridotomy (LPI) in patients with early or moderate PACG and those with primary angle closure and IOP over 30 mmHg. There is no high-quality evidence to support LPI in the treatment of pigmentary glaucoma.
Summary
Evidence from the assessed period supports the IOP-lowering effect of cataract surgery in people with coexisting cataract and glaucoma. CLE is an option in the initial treatment of some patients with PACG as its superiority has been demonstrated against LPI.
MeSH Terms
Shields Classification
Key Concepts6
Lens extraction in people with coexisting cataract and open angle glaucoma is associated with a reduction in intraocular pressure (IOP).
In primary angle-closure glaucoma (PACG), lens extraction and laser peripheral iridotomy (LPI) can be used to open the anterior chamber angle, increase the outflow through the trabecular meshwork and reduce the IOP.
Cataract surgery as an IOP-lowering procedure in people with coexisting cataract and glaucoma has its most important predictor for a greater decrease in a higher preoperative IOP.
The probability for achieving a significant IOP reduction with cataract surgery is highest in primary angle-closure glaucoma (PACG) and pseudoexfoliation glaucoma.
Clear lens extraction (CLE) is associated with better clinical and quality of life outcomes than laser peripheral iridotomy (LPI) in patients with early or moderate primary angle-closure glaucoma (PACG) and those with primary angle closure and IOP over 30 mmHg.
There is no high-quality evidence to support laser peripheral iridotomy (LPI) in the treatment of pigmentary glaucoma.
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