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Clear lens extraction for the management of primary angle closure glaucoma: surgical technique and refractive outcomes in the EAGLE cohort
  1. Alexander C Day1,
  2. David Cooper2,
  3. Jennifer Burr3,
  4. Paul J Foster1,
  5. David S Friedman4,
  6. Gus Gazzard1,
  7. Jemaima Che-Hamzah5,
  8. Tin Aung6,
  9. Craig R Ramsay2,
  10. Augusto Azuara-Blanco7
  1. 1 NIHR Biomedical Research Centre, Moorfields Eye Hospital and University College London, London, UK
  2. 2 Health Services Research Unit, University of Aberdeen, Aberdeen, UK
  3. 3 School of Medicine, University of St Andrews, St Andrews, UK
  4. 4 John Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
  5. 5 Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
  6. 6 Singapore Eye Research Institute, Singapore
  7. 7 Centre for Public Health, Queen’s University Belfast, Belfast, UK
  1. Correspondence to Professor Augusto Azuara-Blanco, Centre for Public Health, Queen’s University Belfast, Belfast BT7 1NN, UK; a.azuara-blanco{at}


Background To describe the surgical technique and refractive outcomes following clear lens extraction (CLE) in the Effectiveness, in Angle-closure Glaucoma, of Lens Extraction trial.

Methods Review of prospectively collected data from a multicentre, randomised controlled trial comparing CLE and laser peripheral iridotomy. Eligible participants were ≥50 years old and newly diagnosed with (1) primary angle closure (PAC) with intraocular pressure above 30 mm Hg or (2) PAC glaucoma. We report the postoperative corrected distance visual acuity (CDVA) and refractive outcomes at 12 and 36 months postoperatively for those who underwent CLE.

Results Of the 419 participants, 208 were randomised to CLE. Mean baseline CDVA was 77.9 (SD 12.4) letters and did not change significantly at 36 months when mean CDVA was 79.9 (SD 10.9) letters. Mean preoperative spherical equivalents were +1.7 (SD 2.3) and +0.08 (SD 0.95) diopters (D) at 36 months. Fifty-nine per cent and 85% eyes were within ±0.5D and ±1.0D of predicted refraction, respectively, at 36 months.

Conclusions Mean CDVA in patients undergoing CLE for angle-closure glaucoma appeared stable over the 3-year study period. Refractive error was significantly reduced with surgery but refractive predictability was suboptimal.

  • glaucoma
  • clinical trial
  • lens and zonules
  • optics and refraction
  • treatment surgery

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  • Contributors AA-B and JB are chief investigators of the EAGLE trial. ACD and DC led the data analysis. AA-B and ACD led the drafting of the manuscript. All authors were actively involved in the interpretation of data and editing of the manuscript.

  • Funding This research grant is funded by the Medical Research Council (MRC G0701604) and managed by the National Institute for Health Research (NIHR-EME 09-800-26) on behalf of the MRC-NIHR partnership. The views and opinions expressed in this article are those of the authors and do not necessarily reflect those of the MRC, the NIHR HTA program, the NIHR, the National Health Service or the Department of Health or the funders that provided institutional support for the study.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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