Cataract Surgery Intraoperative Complications And Postoperative Outcomes In Acute Angle-Closure Attack Patients With Persistent High Intraocular Pressure Despite Medical Treatment
Published 2024 - 42nd Congress of the ESCRS
Reference: PO992 | Type: Poster | DOI: 10.82333/xa5z-e689
Authors: Satomi Kogawa* 1 , Yukihiko Suzuki 1 , Ami Furukawa 1 , Kodai Yamauchi 1 , Takashi Kudo 1 , Shinji Ueno 1
1Hirosaki University Hospital,Hirosaki,Japan
Purpose
To evaluate intraoperative complications and postoperative results in patients with persistent high intraocular pressure (IOP) due to acute angle-closure (AAC) attack despite medical treatment who underwent cataract surgery including a staged core vitrectomy with use of a vitreous cutter when anterior chamber depth could not be maintained.
Setting
Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
Methods
Findings related to intraoperative complications and postoperative IOP in 40 eyes of 39 patients [7 males, 32 females; age 72.9±10.6 years (mean ± standard deviation)] who underwent cataract surgery from 2014 to 2023 for AAC attack and did not achieve IOP normalization after drug treatment were analyzed. IOP was 58.7 ± 12.4 mmHg at the initial visit and 47.8 ± 11.2 mmHg after medical treatment, while anterior chamber depth was 1.90 ± 0.30 mm. In 30 eyes (78%), a vitreous surgical trocar was placed, then cataract surgery was carefully performed while lowering IOP in stages by use of a 25-gauge vitreous cutter.
Results
Intraoperative findings revealed obvious Zinn’s zonule dialysis in 12 eyes (30%). During the initial surgery, IOL insertion into the capsular bag could not be performed in 8 eyes (20%), while that was performed in 32 eyes (80%), including three treated with intracapsular IOL suturing technique. On the day following surgery, IOP was 16.7±11.5 mmHg, significantly lower than preoperative value (p<0.01, paired t-test).
Conclusions
For patients with an AAC attack who do not show normalized IOP with drug treatment, cataract surgery combined with a staged vitrectomy when needed resulted in lowered IOP in many cases. However, in a certain percentage of such patients, an IOL cannot be inserted at the initial surgery due to Zinn’s zonule dialysis, thus sufficient preoperative explanation and careful surgical manipulation are required.