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spencer hayes, laura baker, Alice Chuang, Lauren S Blieden, Robert M Feldman, Nicholas P Bell; Complications of Lens Extraction with Intraocular Lens Placement in Patients with Primary Angle Closure Spectrum Disease. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4924.
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© ARVO (1962-2015); The Authors (2016-present)
To estimate intra- and postoperative complication rates of lens extraction in patients with primary angle closure spectrum disease (PACSD) and anatomically normal angles (ANA).
Patients with PACSD and best-corrected vision (BCVA) 20/80 or better who underwent lens extraction with capsular bag placement of an intraocular lens (LE-IOL) between January 1996 and July 2015 were reviewed. Eyes with previous acute angle closure attack, intraocular incisional surgery or injections, scleral buckle, combined surgery with LE-IOL, or < 3 months follow-up were excluded. PACSD eyes were matched with eyes that had an ANA with BCVA 20/80 or better and had undergone LE-IOL by same surgeon. In the ANA group, additional exclusion criteria included traumatic cataract and secondary glaucoma. The first eligible eye per patient was selected. Demographics and ocular characteristics, including intraocular pressure (IOP), manifest refraction (spherical equivalent), vision (BCVA), corneal keratometry (K1, K2), axial length (AL), and anterior chamber depth (ACD) were recorded. The number and type of intra- and postoperative complications were recorded. Postoperative complications included corneal edema at month 1, cystoid macular edema (CME) at month 1, and not reaching visual potential (worse than 20/25 at 2 consecutive visits after month 1 without any pre-existing conditions). Demographics and baseline ocular characteristics were compared using Fisher’s exact test or 2-sample t-test.
129 patients (67 ANA, 62 PACSD) having LE-IOL by 3 surgeons were included. More females (P=0.032), better vision (P=0.003), shallower anterior chamber (P<0.001), shorter eye (P<0.001), and more hyperopia (P<0.001) were observed in PACSD eyes than in ANA eyes before LE-IOL. Three intraoperative complications occurred in 3 (2%) eyes (1 [1.5%] in ANA, 2 [3%] in PACSD). A total of 15 postoperative complications occurred in 12 (9%) eyes: 4 (6%) eyes in ANA and 8 (13%) in PACSD. Postoperative complications included 4 incidences of corneal edema (1 ANA, 3 PACSD), 3 CME (2 ANA, 1 PACSD), 6 eyes (3 ANA, 3 PACSD) did not reach BCVA goal, and 2 other complications in PACSD.
The incidence of intra- and postoperative complications from LE-IOL was nearly 2 times higher in eyes with PACSD than those with ANA. However, the sample size was not large enough to reach statistical significance.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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