Phacoemulsification versus Laser Peripheral Iridotomy in Early Treatment of Acute Primary Angle-Closure Glaucoma

Purpose: We compared the outcomes of laser iridotomy and primary phacoemulsification when treating acute angle-closure glaucoma. Methods: This study was conducted with 61 patients diagnosed with acute angle closure glaucoma from January, 2005 to January, 2015. The patients received either laser iridotomy or primary phacoemulsification. The age and gender of each patient, differences of intraocular pressure (IOP) before and after treatment, visual acuity, need for IOP lowering agents and complications were analyzed retrospectively at 1-day, 1-month, 6-month and 12-month after the treatment. Patients who received laser iridotomy with phacoemulsification or trabeculectomy were excluded from this study. Additionally, we included only cases in which treatments were given within 3 days after the onset of symptom. Results: Among the 61 patients, 45 patients received laser iridotomy and 16 patients received primary phacoemulsification. One day after the treatment the laser iridotomy group showed better outcome in their visual acuity (log MAR 0.62 +/- 0.51; p = 0.048). At 6-month postoperatively, the primary phacoemulsification group showed better visual acuity (log MAR 0.07 +/- 0.15; p = 0.013). However, at 12-month postoperatively, the visual acuities were not significantly different between the 2 groups. Regarding IOP, at postoperative 1-month, the group of primary phacoemulsification shows significantly lower IOP (9.5 +/- 1.3 mm Hg), compared with the group of laser iridotomy. A significant difference was observed in the number of IOP lowering agents that patients at 12 month after the treatment. There were no severe complications in either group. Conclusions: Following the initial treatment of acute angle-closure glaucoma, the primary phacoemulsification showed no significant differences in postoperative visual acuity, IOP and complications compared to the outcomes of laser iridotomy. Additionally, the need for IOP lowering agents was less in the primary phacoemulsification groups at 1 year after the operation.