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Long-term effects of mild cataract extraction versus laser peripheral iridotomy on anterior chamber morphology in primary angle-closure suspect eyes
  1. Chenxi Yan1,
  2. Yibo Yu1,
  3. Wei Wang1,
  4. Ying Han2,
  5. Ke Yao1
  1. 1 Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
  2. 2 Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Ke Yao, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China; xlren{at}zju.edu.cn; Ying Han; hany{at}vision.ucsf.edu

Abstract

Aim To compare lens extraction (LE) and laser peripheral iridotomy (LPI) on anterior segment morphology in primary angle-closure suspect (PACS) eyes.

Methods This prospective clinical trial included 144 patients with PACS who underwent either LPI or LE. Ultrasound biomicroscopy (UBM) and gonioscopy were performed before and 1 month and 2 years after operation. Main outcomes included UBM parameters and the percentage of residual angle closure.

Results At both 1 month and 2 years of follow-up, LE showed a better effect of relieving anterior chamber crowding and widening the drainage angle, as obtaining a larger anterior chamber depth (ACD), angle opening distance, trabecular iris angle (TIA), trabecular iris space area, trabecular ciliary process distance (TCPD) and a smaller iris curvature (I-Curv) and lens vault (LV) (p<0.001). In the LPI group, angle width increased (angle opening distance at 500 µm from the scleral spur, TIA and trabecular iris space area at 500 µm from the scleral spur) and I-Curv decreased (p<0.001) at 1 month postoperatively, with no significant changes in ACD, LV or TCPD. However, at 2 years after LPI, the angle narrowed with the increase in LV over time, and the proportion of residual angle closure also increased from 21.7% to 30.4% (p<0.001). In contrast, after LE, the widened angle width, flattened iris, deepened ACD, decreased LV and increased TCPD all showed good sustainability in the comparison between 1-month and 2-year follow-up. No residual angle closure was observed either at 1 month or 2 years after LE.

Conclusions LE was prior to LPI in widening the drainage angle. After LPI, there was a narrowing of the angle and an increase in the proportion of residual angle closure over time. LE could achieve a wider angle with no residual angle closure, and the anterior segment parameters were sustainable.

Trial registration number ChiCTR1800016511.

  • Pathology
  • Anterior chamber
  • Glaucoma
  • Lens and zonules

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors CY, KY and YH contributed to the study conception and design. Material preparation, data collection and analysis were performed by CY, YY, WW and KY. The first draft of the manuscript was written by CY. KY is guarantor.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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