Phacoemulsification in filtered chronic angle closure glaucoma eyes

Purpose: To report the results of phacoemulsification in eyes with chronic angle closure glaucoma having a functional filtering bleb.

Methods: A prospective and non-comparative study was undertaken in 60 consecutive eyes of 44 patients having a functional filtering bleb for chronic angle closure glaucoma and undergoing cataract surgery. Only those cases who had intraocular pressure ≤ 21 mmHg over the preceding 6 months without any medical therapy following trabeculectomy were included in the study. All patients underwent phaco­emulsification through a superior clear corneal, three-stepped, 1.5 mm long tunnelled incision and in-the-bag intraocular lens implantation. Surgical difficulties, complications, postoperative intraocular pressure and best-corrected visual acuity were studied and analysed over a follow up of 6 months.

Results: Complications seen during the surgery were iris trauma in 11 eyes (18.33%), thermal corneal burn in four (6.6%), corneal oedema in seven (11.66%), vitreous loss in one (1.6%), breach in rhexis in two (3.3%), fibrinoid reaction in one (1.6%) and early increase in intraocular pressure in one (1.6%). Postoperatively, visual acuity improved in all cases. None of the patients had poor vision that could be attributed to the surgical procedures. Difference in intra-ocular pressure (preoperative 15.37 ± 2.59 mmHg) at all occasions during follow up was found to be statistically insignificant (P > 0.05 using paired t-test). The central anterior chamber depth was statistically significant (P = 0.002) when preoperative (1.90 ± 1.27 mm) was compared to postoperative at 6 months (2.11 ± 1.27 mm).

Conclusion: Phacoemulsification in eyes with a functional filtering bleb for chronic angle closure glaucoma is challenging. However, with slight modifications in technique, it can be accomplished without compromising the functioning of the bleb.