Lens extraction should be considered for PACG

Lens extraction for primary angle-closure glaucoma (PACG) results in good long-term control of intraocular pressure (IOP), and should be considered among the armamentarium of approaches to treat PACG - especially for patients who have hyperopia, or a thick and anteriorly vaulted lens, according to a report in Current Opinion in Ophthalmology.

The authors of the report note that anatomical opening of the angle, IOP reduction, and improved vision are all benefits cited by proponents of lens extraction in PACG.

The evidence base for ophthalmic surgeons to consider lens extraction in the management of PACG has grown stronger recently thanks to randomized controlled trials, case-control studies and cohort studies. Such studies have also added to the discussion of whether trabeculectomy or goniosynechialysis should be combined with lens extraction.

New insights have also been gained thanks to imaging modalities, such as anterior segment optical coherence tomography, that are providing information on the mechanical features of the lens in angle closure. For example, lens thickness and lens vault are now quantifiable.

“A trend is emerging regarding the improvement in IOP control, reduced complication rates and reduced need for IOP-lowering medications in patients who undergo lens extraction for PACG,” the authors state.