EyeWorld India March 2017 Issue

EWAP SECONDARY FEATURE 35 March 2017 remains closed or narrow after cataract surgery or LPI, it can often be traced back to an anteriorly rotated ciliary body. Patients may benefit from endocycloplasty in these cases and if diagnosed preoperatively with an ultrasound biomicroscope may be combined with clear lens extraction. The procedure is performed after cataract surgery and IOL implantation and involves the use of the endoscope’s laser attachment to shrink the posterior ciliary process, which allows the ciliary muscle to rotate back and open the angle. “We still don’t know what the long-term outcomes are of lens removal in PACG. We have 3-year data that says it costs less to take out the lens, that vision and quality of life are better, and that IOP is lower for a few years, but this comes as no big surprise because that is what happens when you take out a cataract in any patient. We don’t know if the additional deepening that you get from lens extraction—and getting additional deepening is an assumption from data from sources other than EAGLE, which you do not get from iridotomy—changes the outcome and prevents progression of the actual angle closure and ultimately, the glaucoma long term,” Dr. Feldman said. EWAP References 1. Azuara-Blanco A, et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): A randomised controlled trial. Lancet . 2016;388:1389–1397. 2. Brown RH, et al. Lens-based glaucoma surgery: Using cataract surgery to reduce intraocular pressure. J Cataract Refract Surg . 2014;40:1255–1262. 3. Panarelli JF, et al. Clinical impact of 8 prospective, randomized, multicenter glaucoma trials. J Glaucoma . 2015;24:64–68. Editors’ note: Dr. Panarelli has financial interests with Aerie Pharmaceuticals (Irvine, California) and Allergan. Drs. Brown and Feldman have no financial interests related to their comments. Contact information Brown : reaymary@comcast.net Feldman : rfeldman@cizikeye.org Panarelli : ilana.nikravesh@mountsinai.org