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New data published in October 2016 shows there is a successful, safe, routine surgical procedure that has been restoring eyesight for ages, and it may be the answer to treating primary closed-angle glaucoma (PCAG). Researchers at Queen’s University in Belfast, Northern Ireland, working with teams from St. Andrews and Aberdeen Universities, have discovered that standard cataract surgery is actually more effective than current surgical procedures at treating PCAG.
The current surgical treatments for primary closed-angle glaucoma usually begin with laser peripheral iridotomy, which opens the drainage pathways to allow fluid to drain. If this fails, it is usually followed by a trabeculectomy, which creates an opening in the wall of the eye that allows a slow drainage of fluid. In both cases, medical management with eye drops often follows to further control fluid pressure. These standard procedures do not always work, and can sometimes lead to severe complications.
The researchers at Queen’s University have been working to explore new approaches to glaucoma treatment, and have recently settled on the cataract-correcting clear lens extraction surgery as a particularly promising candidate.
The clinical trials were conducted between 2009 and 2011 in thirty hospitals in five countries, with 419 participants enrolled. Inclusion criteria were:
The experimental group underwent the clear lens extraction surgeries, while the control group had the traditional surgical procedures. Both groups were tracked and brought back three years later for a progress check. The researchers discovered that:
There were complications in 75 of the patients in the experimental group, and 25 from the control group, but none of them were considered serious. Meanwhile, far fewer participants from the experimental group required further treatment to control their fluid pressure, either through medications or more surgery. And those patients who had the cataract surgery enjoyed better vision as compared with patients in the standard care control group. Overall, the study authors concluded that the trials offer “robust evidence that initial clear-lens extraction is associated with better clinical and patient-reported outcomes, and that this approach is likely to be cost-effective in a publicly funded health system.”1
This is a promising step in the right direction. According to Carlo E. Traverso, MD, from Università di Genova, Italy, this study’s findings highlight advances in cataract surgical techniques and that the findings are both clinically relevant and have widespread practical implications. “While not yet sufficient to justify using clear-lens extraction to treat all patients with primary angle closure with or without glaucoma, the findings of this trial could have positive implications for areas where angle closure is most prevalent, particularly east Asia, or where health-care resources are scarce and patients might not have easy access to medications and monitoring. A not yet proven potential additional benefit with clear-lens extraction is that early intervention might prevent blindness.”2
As intriguing as these results are, the question of next steps deserves an answer, and that takes further research. By donating to Glaucoma Research Foundation, you are supporting cutting edge research like this, that might one day cure this disease.
1Azuara-Blanco, A, Burr, J, et al, and the EAGLE study group. “Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial.” Lancet. 2016; 388: 1389 – 1397.
2Traverso, Carlo E. “Clear-lens extraction as a treatment for primary angle closure.” Lancet. 2016; 388: Issue 1352 – 1354.
Last reviewed on January 17, 2017