Visual acuity and intraocular pressure after cataract extraction in phacomorphic angle closure

Abstract

Purpose : Phacomorphic angle closure (PmAC) is an urgent condition that can cause permanent glaucomatous nerve damage if not treated promptly. The index retrospective cohort study examines the visual acuity (VA) and intraocular pressure (IOP) outcomes of cataract extraction in patients with PmAC.

Methods : A review of medical records from a single tertiary eye facility from January 2014 to August 2019 with a diagnosis of PmAC was conducted. Cases with other etiologies of increased IOP, failure to meet the minimum follow-up period, and those who did not proceed with cataract surgery were excluded. A total of 62 eyes were included. Data were then processed based on age, gender, chief complaint, duration of symptoms, pre-operative and post-operative VA at one month, pre-operative and post-operative IOP at one month, intervention performed, and vertical cup-disc ratio (VCDR). VA was converted to Logarithm of Minimal Angle of Resolution (LogMAR) units for statistical analysis. For non-numeric VA worse than 20/200, LogMAR conversions were adapted from the Freiburg Visual Acuity Test. Descriptive statistics were used to report demographic data, chief complaint, duration of symptoms, type of cataract surgery done, and other therapeutic modalities instituted. Paired t-test, Pearson chi, Spearman rho, and Kruskal-Wallis tests were used for statistical correlation.

Results : There was a statistically significant improvement in VA (pre-operative VA of 2.06 ± 0.39 LogMAR, with a post-operative mean change in VA of 1.16 ± 1.01 LogMAR, p<0.0001) and reduction in IOP (pre-operative IOP 52.74 ± 10.36 mmHg, with a post-operative mean change of 36.4 ± 13.14 mmHg, p<0.0001) following cataract extraction. In 56.45% of cases, post-operative VA was ≥20/50. There was also a significant association between duration of symptoms (until the patient was evaluated by a glaucoma specialist) and VCDR (p=0.016). There were cases that needed additional medications and/or surgery (19.35%), and a cup-disc ratio suspicious for glaucomatous nerve damage was found in approximately 51.61% of patients. There was a statistically significant association between the duration of symptoms and post-operative VA (X2 =18.72, p=0.044).

Conclusions : Prompt cataract extraction is generally effective in the management of PmAC, with significant improvements in VA and IOP. Duration of symptoms until consultation may correlate with the post-operative VA and VCDR.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.