Skip to main content
SpringerLink
Log in

Lens Extraction for Angle-Closure Glaucoma

  • Chapter
  • First Online:
Surgical Innovations in Glaucoma

  • 1211 Accesses

Abstract

Angle-closure glaucoma (ACG) is a growing problem and represents a significant proportion of glaucomas in Inuit, Chinese, and other Asian populations. Accurate and timely diagnosis of ACG is essential to its successful management. While clinical examination remains a critical linchpin to proper recognition and diagnosis, adjunctive imaging is also of great utility. This chapter reviews the classification and mechanism of the disease as well as a focus on the treatment of lens-mediated angle closure. Unique considerations for lens extraction in the angle-closure eye are reviewed including stabilization of the anterior chamber, pupil management, zonular laxity strategies, and lens disassembly techniques, and IOL choices are addressed as well as adjunctive procedures which may be performed to address differing mechanisms and severity of ACG. Finally, as these eyes are more prone to malignant glaucoma, the surgical management of this condition is also addressed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Foster PJ. The epidemiology of primary angle closure and associated glaucomatous optic neuropathy. Semin Ophthalmol. 2002;17:50–8.

    Article  PubMed  Google Scholar 

  2. Bonomi L, Marchini G, Marraffa M, et al. Prevalence of glaucoma and intraocular pressure distribution in a defined population. The Egna-Neumarkt Study. Ophthalmology. 1998;105:209–15.

    Article  CAS  PubMed  Google Scholar 

  3. Mitchell P, Smith W, Attebo K, Healey PR. Prevalence of open-angle glaucoma in Australia. The Blue Mountains Eye Study. Ophthalmology. 1996;103:1661–9.

    Article  CAS  PubMed  Google Scholar 

  4. Bankes JL, Perkins ES, Tsolakis S, Wright JE. Bedford glaucoma survey. Br Med J. 1968;1:791–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Coffey M, Reidy A, Wormald R, et al. Prevalence of glaucoma in the west of Ireland. Br J Ophthalmol. 1993;77:17–21.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Hollows FC, Graham PA. Intra-ocular pressure, glaucoma, and glaucoma suspects in a defined population. Br J Ophthalmol. 1966;50:570–86.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Wensor MD, McCarty CA, Stanislavsky YL, et al. The prevalence of glaucoma in the Melbourne Visual Impairment Project. Ophthalmology. 1998;105:733–9.

    Article  CAS  PubMed  Google Scholar 

  8. Klein BE, Klein R, Sponsel WE, et al. Prevalence of glaucoma. The Beaver Dam Eye Study. Ophthalmology. 1992;99:1499–504.

    Article  CAS  PubMed  Google Scholar 

  9. Dielemans I, Vingerling JR, Wolfs RC, et al. The prevalence of primary open-angle glaucoma in a population-based study in The Netherlands. The Rotterdam Study. Ophthalmology. 1994;101:1851–5.

    Article  CAS  PubMed  Google Scholar 

  10. Bengtsson B. The prevalence of glaucoma. Br J Ophthalmol. 1981;65:46–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Tielsch JM, Katz J, Singh K, et al. A population-based evaluation of glaucoma screening: the Baltimore Eye Survey. Am J Epidemiol. 1991;134:1102–10.

    CAS  PubMed  Google Scholar 

  12. Buhrmann RR, Quigley HA, Barron Y, et al. Prevalence of glaucoma in a rural East African population. Invest Ophthalmol Vis Sci. 2000;41:40–8.

    CAS  PubMed  Google Scholar 

  13. Rotchford AP, Kirwan JF, Muller MA, et al. Temba glaucoma study: a population-based cross-sectional survey in urban South Africa. Ophthalmology. 2003;110:376–82.

    Article  PubMed  Google Scholar 

  14. Van Rens GH, Arkell SM, Charlton W, Doesburg W. Primary angle-closure glaucoma among Alaskan Eskimos. Doc Ophthalmol. 1988;70:265–76.

    Article  PubMed  Google Scholar 

  15. Arkell SM, Lightman DA, Sommer A, et al. The prevalence of glaucoma among Eskimos of northwest Alaska. Arch Ophthalmol. 1987;105:482–5.

    Article  CAS  PubMed  Google Scholar 

  16. Bourne RR, Sorensen KE, Klauber A, et al. Glaucoma in East Greenlandic Inuit – a population survey in Ittoqqortoormiit (Scoresbysund). Acta Ophthalmol Scand. 2001;79:462–7.

    Article  CAS  PubMed  Google Scholar 

  17. Congdon NG, Quigley HA, Hung PT, et al. Screening techniques for angle-closure glaucoma in rural Taiwan. Acta Ophthalmol Scand. 1996;74:113–9.

    Article  CAS  PubMed  Google Scholar 

  18. He M, Foster PJ, Ge J, et al. Prevalence and clinical characteristics of glaucoma in adult Chinese: a population-based study in Liwan District, Guangzhou. Invest Ophthalmol Vis Sci. 2006;47:2782–8.

    Article  PubMed  Google Scholar 

  19. Foster PJ, Baasanhu J, Alsbirk PH, et al. Glaucoma in Mongolia. A population-based survey in Hovsgol province, northern Mongolia. Arch Ophthalmol. 1996;114:1235–41.

    Article  CAS  PubMed  Google Scholar 

  20. Xu L, Zhang L, Xia CR, et al. The prevalence and its effective factors of primary angle-closure glaucoma in defined populations of rural and urban in Beijing [in Chinese]. Zhonghua Yan Ke Za Zhi. 2005;41:8–14.

    PubMed  Google Scholar 

  21. Foster PJ, Oen FT, Machin D, et al. The prevalence of glaucoma in Chinese residents of Singapore: a cross-sectional population survey of the Tanjong Pagar district. Arch Ophthalmol. 2000;118:1105–11.

    Article  CAS  PubMed  Google Scholar 

  22. Casson RJ, Newland HS, Muecke J, et al. Prevalence of glaucoma in rural Myanmar: the Meiktila Eye Study. Br J Ophthalmol. 2007;91:710–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Salmon JF, Mermoud A, Ivey A, et al. The prevalence of primary angle closure glaucoma and open angle glaucoma in Mamre, Western Cape, South Africa. Arch Ophthalmol. 1993;111:1263–9.

    Article  CAS  PubMed  Google Scholar 

  24. Dandona L, Dandona R, Mandal P, et al. Angle-closure glaucoma in an urban population in southern India. The Andhra Pradesh eye disease study. Ophthalmology. 2000;107:1710–6.

    Article  CAS  PubMed  Google Scholar 

  25. Bourne RR, Sukudom P, Foster PJ, et al. Prevalence of glaucoma in Thailand: a population based survey in Rom Klao District, Bangkok. Br J Ophthalmol. 2003;87:1069–74.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Vijaya L, George R, Arvind H, et al. Prevalence of angle-closure disease in a rural southern Indian population. Arch Ophthalmol. 2006;124:403–9.

    Article  PubMed  Google Scholar 

  27. Ramakrishnan R, Nirmalan PK, Krishnadas R, et al. Glaucoma in a rural population of southern India: the Aravind comprehensive eye survey. Ophthalmology. 2003;110:1484–90.

    Article  CAS  PubMed  Google Scholar 

  28. Rahman MM, Rahman N, Foster PJ, et al. The prevalence of glaucoma in Bangladesh: a population based survey in Dhaka division. Br J Ophthalmol. 2004;88:1493–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Shiose Y, Kitazawa Y, Tsukahara S, et al. Epidemiology of glaucoma in Japan – a nationwide glaucoma survey. Jpn J Ophthalmol. 1991;35:133–55.

    CAS  PubMed  Google Scholar 

  30. Yamamoto T, Iwase A, Araie M, et al. The Tajimi Study report 2: prevalence of primary angle closure and secondary glaucoma in a Japanese population. Ophthalmology. 2005;112:1661–9.

    Article  PubMed  Google Scholar 

  31. Quigley HA. Number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90:262–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Foster PJ, Johnson GJ. Glaucoma in China: how big is the problem? Br J Ophthalmol. 2001;85:1277–82.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Van Herick W, Shaffer RN, Schwartz A. Estimation of width of angle of anterior chamber. Incidence and significance of the narrow angle. Am J Ophthalmol. 1969;68:626–9.

    PubMed  Google Scholar 

  34. Lowe RF. Aetiology of the anatomical basis for primary angle-closure glaucoma. Biometrical comparisons between normal eyes and eyes with primary angle-closure glaucoma. Br J Ophthalmol. 1970;54:161–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Gazzard G, Foster PJ, Friedman DS, et al. Light to dark physiological variation in iridotrabecular angle width. Br J Ophthalmol. 2004. Available at: http://bjo.bmj.com/cgi/content/full/88/11/DC1/1. Accessed 20 Apr 2013.

  36. Quigley HA. Long-term follow-up of laser iridotomy. Ophthalmology. 1981;88:218–24.

    Article  CAS  PubMed  Google Scholar 

  37. He M, Friedman DS, Ge J, et al. Laser peripheral iridotomy in primary angle-closure suspects: biometric and gonioscopic outcomes: the Liwan Eye Study. Ophthalmology. 2007;114:494–500.

    Article  PubMed  Google Scholar 

  38. He M, Friedman DS, Ge J, et al. Laser peripheral iridotomy in eyes with narrow drainage angles: ultrasound biomicroscopy outcomes. The Liwan Eye Study. Ophthalmology. 2007;114:1513–9.

    Article  PubMed  Google Scholar 

  39. Greve EL. Primary angle closure glaucoma: extracapsular cataract extraction or filtering procedure? Int Ophthalmol. 1988;12:157–62.

    Article  CAS  PubMed  Google Scholar 

  40. Steuhl KP, Marahrens P, Frohn C, Frohn A. Intraocular pressure and anterior chamber depth before and after extracapsular cataract extraction with posterior chamber lens implantation. Ophthalmic Surg. 1992;23:233–7.

    CAS  PubMed  Google Scholar 

  41. Yang CH, Hung PT. Intraocular lens position and anterior chamber angle changes after cataract extraction in eyes with primary angle-closure glaucoma. J Cataract Refract Surg. 1997;23:1109–13.

    Article  CAS  PubMed  Google Scholar 

  42. Hayashi K, Hayashi H, Nakao F, Hayashi F. Changes in anterior chamber angle width and depth after intraocular lens implantation in eyes with glaucoma. Ophthalmology. 2000;107:698–703.

    Article  CAS  PubMed  Google Scholar 

  43. Tham CC, Lai JS, Lam DS. Changes in AC angle width and depth after IOL implantation in eyes with glaucoma. Ophthalmology. 2001;108:428–9.

    Article  CAS  PubMed  Google Scholar 

  44. Lam DS, Leung DY, Tham CC, et al. Randomized trial of early phacoemulsification versus peripheral iridotomy to prevent intraocular pressure rise after acute primary angle closure. Ophthalmology. 2008;115:1134–40.

    Article  PubMed  Google Scholar 

  45. Wishart PK, Atkinson PL. Extracapsular cataract extraction and posterior chamber lens implantation in patients with primary chronic angle-closure glaucoma: effect on intraocular pressure control. Eye (Lond). 1989;3(Pt 6):706–12.

    Article  Google Scholar 

  46. Gunning FP, Greve EL. Uncontrolled primary angle closure glaucoma: results of early intercapsular cataract extraction and posterior chamber lens implantation. Int Ophthalmol. 1991;15:237–47.

    Article  CAS  PubMed  Google Scholar 

  47. Acton J, Salmon JF, Scholtz R. Extracapsular cataract extraction with posterior chamber lens implantation in primary angle-closure glaucoma. J Cataract Refract Surg. 1997;23:930–4.

    Article  CAS  PubMed  Google Scholar 

  48. Gunning FP, Greve EL. Lens extraction for uncontrolled angle-closure glaucoma: long-term follow-up. J Cataract Refract Surg. 1998;24:1347–56.

    Article  CAS  PubMed  Google Scholar 

  49. Roberts TV, Francis IC, Lertusumitkul S, et al. Primary phacoemulsification for uncontrolled angle-closure glaucoma. J Cataract Refract Surg. 2000;26:1012–6.

    Article  CAS  PubMed  Google Scholar 

  50. Hayashi K, Hayashi H, Nakao F, Hayashi F. Effect of cataract surgery on intraocular pressure control in glaucoma patients. J Cataract Refract Surg. 2001;27:1779–86.

    Article  CAS  PubMed  Google Scholar 

  51. Jacobi PC, Dietlein TS, Luke C, et al. Primary phacoemulsification and intraocular lens implantation for acute angle-closure glaucoma. Ophthalmology. 2002;109:1597–603.

    Article  PubMed  Google Scholar 

  52. Khokar K, Pangtey M. Phacoemulsification in filtered chronic angle closure glaucoma eyes. Clin Experiment Ophthalmol. 2002;30:256–60.

    Article  Google Scholar 

  53. Ming Zhi Z, Lim AS, Yin Wong T. A pilot study of lens extraction in the management of acute primary angle-closure glaucoma. Am J Ophthalmol. 2003;135:534–6.

    Article  PubMed  Google Scholar 

  54. Kubota T, Toguri I, Onizuka N, Matsuura T. Phacoemulsification and intraocular lens implantation for angle closure glaucoma after the relief of pupillary block. Ophthalmologica. 2003;217:325–8.

    Article  PubMed  Google Scholar 

  55. Tham CC, Kwong YY, Leung DY, et al. Phacoemulsification versus combined phacotrabeculectomy in medically uncontrolled chronic angle closure glaucoma with cataract. Ophthalmology. 2009;116:725–31.

    Article  PubMed  Google Scholar 

  56. Tham CC, Kwong YY, Baig N, et al. Phacoemulsification versus trabeculectomy in medically uncontrolled chronic angle closure glaucoma without cataract. Ophthalmology. 2013;120:62–7.

    Article  PubMed  Google Scholar 

  57. Tham CC, Kwong YY, Leung DY, et al. Phacoemulsification versus combined phacotrabeculectomy in medically controlled chronic angle closure glaucoma with cataract. Ophthalmology. 2008;115:2167–73.

    Article  PubMed  Google Scholar 

  58. Chang DF. Pars plana vitreous tap for phacoemulsification in the crowded eye. J Cataract Refract Surg. 2001;27(12):1911–4.

    Article  CAS  PubMed  Google Scholar 

  59. McCannel MA. A retrievable suture idea for anterior uveal problems. Ophthalmic Surg. 1976;7:98–103.

    CAS  PubMed  Google Scholar 

  60. Siepser SB. The closer chamber slipping suture technique for iris repair. Ann Ophthalmol. 1994;26:71–2.

    CAS  PubMed  Google Scholar 

  61. Little BC, Smith JH, Packer M. Little capsulorhexis tear-out rescue. J Cataract Refract Surg. 2006;32(9):1420–2.

    Article  PubMed  Google Scholar 

  62. Bopp S, Lucke K. Chronic cystoid macular edema in an eye with a capsule defect and posteriorly dislocated capsular tension ring. J Cataract Refract Surg. 2003;29:603–8.

    Article  PubMed  Google Scholar 

  63. Bhattacharjee H, Bhattacharjee K, Das A, et al. Management of a posteriorly dislocated endocapsular tension ring and a foldable acrylic intraocular lens. J Cataract Refract Surg. 2004;30:243–6.

    Article  PubMed  Google Scholar 

  64. Hasanee K, Ahmed IK. Capsular tension rings: update on endocapsular support devices. Ophthalmol Clin North Am. 2006;19:507–19.

    PubMed  Google Scholar 

  65. Boomer JA, Jackson DW. Anatomic evaluation of the Morcher capsular tension ring by ultrasound biomicroscopy. J Cataract Refract Surg. 2006;32(5):846–8.

    Article  PubMed  Google Scholar 

  66. Tribus C, Alge CS, Haritoglou C, et al. Indications and clinical outcome of capsular tension ring (CTR) implantation: a review of 9528 cataract surgeries. Clin Ophthalmol. 2007;1:65–9.

    PubMed Central  PubMed  Google Scholar 

  67. Hasanee K, Butler M, Ahmed IK. Capsular tension rings and related devices: current concepts. Curr Opin Ophthalmol. 2006;17:31–41.

    PubMed  Google Scholar 

  68. DeBry P, Olson RJ, Crandall AS. Comparison of energy required for phaco-chop and divide and conquer phacoemulsification. J Cataract Refract Surg. 1998;24:689–92.

    Article  CAS  PubMed  Google Scholar 

  69. Wong T, Hingorani M, Lee V. Phacoemulsification time and power requirements in phaco chop and divide and conquer nucleofractis techniques. J Cataract Refract Surg. 2000;26:1374–8.

    Article  CAS  PubMed  Google Scholar 

  70. Pirazzoli G, D’Eliseo D, Ziosi M, Acciarri R. Effects of phacoemulsification time on the corneal endothelium using phacofracture and phaco chop techniques. J Cataract Refract Surg. 1996;22:967–9.

    Article  CAS  PubMed  Google Scholar 

  71. Guell JL, Velasco F, Malecaze F, et al. Secondary Artisan-Verisyse aphakic lens implantation. J Cataract Refract Surg. 2005;31:2266–71.

    Article  PubMed  Google Scholar 

  72. Tahzib NG, Nuijts RM, Wu WY. Long-term study of Artisan phakic intraocular lens implantation for the correction of moderate to high myopia. Ophthalmology. 2007;114:1133–42.

    Article  PubMed  Google Scholar 

  73. Saxena R, Boekhoorn SS, Mulder PG, et al. Long-term follow-up of endothelial cell change after Artisan phakic intraocular lens implantation. Ophthalmology. 2008;115:608–13.

    Article  PubMed  Google Scholar 

  74. Agarwal A, Jacob S, Kumar DA, et al. Handshake technique for glued intrascleral haptic fixation of a posterior chamber intraocular lens. J Cataract Refract Surg. 2013;39:317–22.

    Article  PubMed  Google Scholar 

  75. Tran HV, Liebmann JM, Ritch R. Iridociliary apposition in plateau iris persists after cataract extraction. Am J Ophthalmol. 2003;135:40–3.

    Article  PubMed  Google Scholar 

  76. Podbielski DW, Varma DK, Tam DY, Ahmed IIK. Endocycloplasty: a new technique for managing angle-closure glaucoma secondary to plateau iris syndrome. Glaucoma Today. Oct 2010.

    Google Scholar 

  77. Shingleton BJ, Chang MA, Bellows AR, Thomas JV. Surgical goniosynechialysis for angle-closure glaucoma. Ophthalmology. 1990;97:551–6.

    Article  CAS  PubMed  Google Scholar 

  78. Tanihara H, Nishiwaki K, Nagata M. Surgical results and complications of goniosynechialysis. Graefes Arch Clin Exp Ophthalmol. 1992;230:309–13.

    Article  CAS  PubMed  Google Scholar 

  79. Teekhasaenee C, Ritch R. Combined phacoemulsification and goniosynechialysis for uncontrolled chronic angle-closure glaucoma after acute angle-closure glaucoma. Ophthalmology. 1999;106:669–74.

    Article  CAS  PubMed  Google Scholar 

  80. Harasymowycz PJ, Papamatheakis DG, Ahmed I, et al. Phacoemulsification and goniosynechialysis in the management of unresponsive primary angle closure. J Glaucoma. 2005;14:186–9.

    Article  PubMed  Google Scholar 

  81. Fakhrale G, Vahedian Z, Moghimi S, et al. Phacoemulsification and goniosynechialysis for the management of refractory acute angle closure. Eur J Ophthalmol. 2012;22:714–8.

    Google Scholar 

  82. Canlas OA, Ishikawa H, Liebmann JM, et al. Ultrasound biomicroscopy before and after goniosynechialysis. Am J Ophthalmol. 2001;132:570–1.

    Article  CAS  PubMed  Google Scholar 

  83. Fang AW, Yang XJ, Nie L, Qu J. Endoscopically controlled goniosynechialysis in managing synechial angle-closure glaucoma. J Glaucoma. 2010;19:19–23.

    Article  PubMed  Google Scholar 

  84. Luntz MH, Rosenblatt M. Malignant glaucoma. Surv Ophthalmol. 1987;32:73–93.

    Article  CAS  PubMed  Google Scholar 

  85. Quigley HA, Friedman DS, Congdon NG. Possible mechanisms of primary angle-closure and malignant glaucoma. J Glaucoma. 2003;12:167–80.

    Article  PubMed  Google Scholar 

  86. Razeghinejad MR, Amini H, Esfandiari H. Lesser anterior chamber dimensions in women may be predisposing factor for malignant glaucoma. Med Hypotheses. 2005;64:572–4.

    Article  PubMed  Google Scholar 

  87. Prata TS, Dorairaj S, De Moraes CG, et al. Is pre-operative ciliary body and iris anatomical configuration a predictor of malignant glaucoma development? Clin Experiment Ophthalmol. 2013;41:541–5.

    Article  PubMed  Google Scholar 

  88. Cashwell LF, Martin TJ. Malignant glaucoma after laser iridotomy. Ophthalmology. 1992;99:651–8.

    Article  CAS  PubMed  Google Scholar 

  89. Muqit MM, Menage MJ. Malignant glaucoma after phacoemulsification: treatment with diode laser cyclophotocoagulation. J Cataract Refract Surg. 2007;33:130–2.

    Article  PubMed  Google Scholar 

  90. Simmons RJ. Malignant glaucoma. Br J Ophthalmol. 1972;56:263–72.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  91. Chander PA, Grant WM. Mydriatic-cycloplegic treatment in malignant glaucoma. Arch Ophthalmol. 1962;68:353–9.

    Article  Google Scholar 

  92. Weiss DI, Shaffer RN, Harrington DO. Treatment of malignant glaucoma with intravenous mannitol infusion. Medical reformation of the anterior chamber by means of an osmotic agent: a preliminary report. Arch Ophthalmol. 1963;69:154–8.

    Article  CAS  PubMed  Google Scholar 

  93. Little BC. Treatment of aphakic malignant glaucoma using Nd:YAG laser posterior capsulotomy. Br J Ophthalmol. 1994;78:499–501.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  94. Brown RH, Lynch MG, Tearse JE, Nunn RD. Neodymium-YAG vitreous surgery for phakic and pseudophakic malignant glaucoma. Arch Ophthalmol. 1986;104:1464–6.

    Article  CAS  PubMed  Google Scholar 

  95. Epstein DL, Steinert RF, Puliafito CA. Neodymium-YAG laser therapy to the anterior hyaloid in aphakic malignant (ciliovitreal block) glaucoma. Am J Ophthalmol. 1984;98:137–43.

    CAS  PubMed  Google Scholar 

  96. Carassa RG, Bettin P, Fiori M, Brancato R. Treatment of malignant glaucoma with contact transscleral cyclophotocoagulation. Arch Ophthalmol. 1999;117:688–90.

    Article  CAS  PubMed  Google Scholar 

  97. Stumpf TH, Austin M, Bloom PA, et al. Transscleral cyclodiode laser photocoagulation in the treatment of aqueous misdirection syndrome. Ophthalmology. 2008;115:2058–61.

    Article  PubMed  Google Scholar 

  98. Sharma A, Sii F, Shah P, Kirkby GR. Vitrectomy-phacoemulsification-vitrectomy for the management of aqueous misdirection syndromes in phakic eyes. Ophthalmology. 2006;113:1968–73.

    Article  PubMed  Google Scholar 

  99. Harbour JW, Rubsamen PE, Palmberg P. Pars plana vitrectomy in the treatment of phakic and pseudophakic malignant glaucoma. Arch Ophthalmol. 1996;114:1073–8.

    Article  CAS  PubMed  Google Scholar 

  100. Bitrian E, Caprioli J. Pars plana anterior vitrectomy, hyaloido-zonulectomy, and iridectomy for aqueous humor misdirection. Am J Ophthalmol. 2010;150:82–7.

    Article  PubMed  Google Scholar 

  101. Dave P, Senthil S, Rao HL, Garudadri CS. Treatment outcomes in malignant glaucoma. Ophtholmology. 2013;120:984–90.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, University of Toronto, 340 College Street, Suite 400, Toronto, ON, M5T 3A9, Canada

    Diamond Y. Tam MD

Authors
  1. Diamond Y. Tam MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Diamond Y. Tam MD .

Editor information

Editors and Affiliations

  1. Department of Surgery, Rocky Vista University, Parker, CO, USA

    John R. Samples MD

  2. Western Glaucoma Foundation, Portland, OR, USA

    John R. Samples MD

  3. Cornea Consultants of Colorado, Littleton, CO, USA

    John R. Samples MD

  4. The Eye Clinic, Portland, OR, USA

    John R. Samples MD

  5. Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada

    Iqbal Ike K. Ahmed MD, FRCSC

Electronic supplementary material

Below is the link to the electronic supplementary material.

Non-compression gonioscopic view of peripheral anterior synechiae (Video courtesy of Ike K. Ahmed, MD) (MPG 3844 kb)

In this video, it can be seen that after a small amount of dispersive OVD is injected into the anterior chamber, further deepening is unable to be achieved, even with a high-viscosity OVD, which when injected is pushed immediately back out of the eye. In order to create sufficient space in the anterior chamber to safely perform lens extraction, a pars plana tap is performed 4 mm posterior to the limbus. After the pars plana tap, the anterior chamber is comfortably deepened with a high-viscosity viscoadaptive OVD and, in this case, mini-sphincterotomies performed to assist in pupil management (Video courtesy of Ike K. Ahmed, MD) (MPG 123006 kb)

In this angle-closure patient who underwent concurrent lens extraction, focal areas of atonicity were noted which were closed with 10-0 polypropylene pupilloplasty sutures. The nasal area is closed with an intraocular microtying technique with microinstrumentation in the anterior chamber, and the temporal iris is sutured using the McCannel technique (MOV 907932 kb)

In this angle-closure patient who also underwent concurrent lens extraction, a 3-clock-hour atonic area was noted and closed with a partial iris cerclage suture using 10-0 polypropylene suture again. This is tied with a modified McCannel technique using a microtying forceps to bring one end of the suture intraocularly to eliminate the need to bring iris to the corneal incision. This results in less iris pulling and manipulation (MOV 588788 kb)

978-1-4614-8348-9_25_MOESM5_ESM.mov

In this angle-closure patient with an intumescent white cataract, prior to performing the capsulorhexis, the anterior capsule is punctured with a 27 gauge hypodermic needle and cortex immediately aspirated upon capsule puncture in order to decompress the contents of the capsular bag and decrease forward pressure on the anterior capsule. In the video, it can still be appreciated that during capsulorhexis, it exhibits a tendency to proceed outwards towards the equator and thus it was kept purposely on the small side (MOV 198633 kb)

978-1-4614-8348-9_25_MOESM6_ESM.mov

When the capsulorhexis proceeds too far towards the lens equator, it may be rescued using a tear-in technique. The flap should be folded over and pulled centrally to achieve a “boomerang” return of the trajectory of the capsulorhexis rescuing it from the equator. It can be seen in this angle-closure patient that even after the initial rescue maneuver, the capsulorhexis still has the tendency to proceed outwards due to the high lens vault and steep anterior capsular downward slope. As a result, much of the remainder of the capsulorhexis performed using a tear-in technique as well (MOV 544741 kb)

978-1-4614-8348-9_25_MOESM7_ESM.mov

This video illustrates the technique of suturing the capsular tension segment using a double armed 9-0 polypropylene suture, a 26 gauge hypodermic needle in which to dock the suture, and a partial-thickness scleral scratch incision made at the anticipated anteroposterior of the ciliary sulcus. One arm of the suture is passed through the eyelet of the CTS, while the other arm is passed outside of the eyelet (MOV 509349 kb)

This video illustrates a case of spherophakia-induced angle-closure glaucoma. This patient underwent lens extraction with capsular tension ring implantation. The CTR was injected early on to achieve equatorial expansion and prevent collapse during phacoemulsification. When a CTR is injected early, it is imperative that definitive and careful viscodissection occur between the capsule and the cortex to avoid the CTR entrapping cortical material. In this case, the patient undergoes concurrent ECP and GSL. The CTR can be seen endoscopically (Video courtesy of Ike K. Ahmed, MD) (MPG 152571 kb)

This video illustrates the injection of a CTR with a CTS being held in position by an inverted iris hook (Video courtesy of Ike K. Ahmed, MD) (MOV 166226 kb)

This video illustrates endoscopic cycloplasty, the technique by which ablation of the ciliary processes is performed beginning with the tail of the process causing a downward rotation or shrinking of the ciliary processes thereby allowing the iris to fall posteriorly and open the angle (AVI 3949 kb)

This video illustrates goniosynechialysis under visualization with a gonio mirror performed with anterior segment microinstrumentation (Video courtesy of Ike K. Ahmed, MD) (MPG 35928 kb)

In this patient who had a penetrating keratoplasty previously, the gonio mirror prevented adequate view of the angle. As a result, GSL was performed with the assistance of an endoscopic probe (Video courtesy of Ike K. Ahmed, MD) (MPG 33393 kb)

A vitrectomy-hyaloidotomy-iridectomy (VHI) is performed using an automated vitreous cutter in the anterior chamber through the previous LPI this patient had. With the assistance of anterior segment microforceps to grasp the iris, the vitrector can be placed as peripheral as possible to avoid making an excessively large iridectomy. The vitrector is then placed further posteriorly to cut through the zonules and hyaloid face and into the vitreous cavity. This procedure can also be performed from the pars plana cutting the vitreous first, then the hyaloid face, and the zonules and finally emerging through the peripheral iris into the anterior chamber (MOV 417549 kb)

Video 25.5

In this angle-closure patient with an intumescent white cataract, prior to performing the capsulorhexis, the anterior capsule is punctured with a 27 gauge hypodermic needle and cortex immediately aspirated upon capsule puncture in order to decompress the contents of the capsular bag and decrease forward pressure on the anterior capsule. In the video, it can still be appreciated that during capsulorhexis, it exhibits a tendency to proceed outwards towards the equator and thus it was kept purposely on the small side (MOV 198633 kb)

Video 25.6

When the capsulorhexis proceeds too far towards the lens equator, it may be rescued using a tear-in technique. The flap should be folded over and pulled centrally to achieve a “boomerang” return of the trajectory of the capsulorhexis rescuing it from the equator. It can be seen in this angle-closure patient that even after the initial rescue maneuver, the capsulorhexis still has the tendency to proceed outwards due to the high lens vault and steep anterior capsular downward slope. As a result, much of the remainder of the capsulorhexis performed using a tear-in technique as well (MOV 544741 kb)

Video 25.7

This video illustrates the technique of suturing the capsular tension segment using a double armed 9-0 polypropylene suture, a 26 gauge hypodermic needle in which to dock the suture, and a partial-thickness scleral scratch incision made at the anticipated anteroposterior of the ciliary sulcus. One arm of the suture is passed through the eyelet of the CTS, while the other arm is passed outside of the eyelet (MOV 509349 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Tam, D.Y. (2014). Lens Extraction for Angle-Closure Glaucoma. In: Samples, J.R., Ahmed, I.I.K. (eds) Surgical Innovations in Glaucoma. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8348-9_25

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-8348-9_25

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8347-2

  • Online ISBN: 978-1-4614-8348-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation