Cataract surgery in the setting of angle closure glaucoma is very challenging because the anterior chamber is very shallow, the iris may be ischemic, the pupil will be small, and there could already be underlying optic nerve damage to limit the post-op vision. Cataract surgery is also very helpful in cases of narrow angle glaucoma or angle closure glaucoma since we remove the 4-5mm thick human lens (the cataract) and replace it with a man-made lens (the IOL) which is about 1 mm thin. This allows the narrow angle to instantly widen to a normal, wide open angle and it makes the anterior chamber deep. This video shows our guest surgeon’s approach to performing cataract surgery in the setting of angle closure glaucoma. I am certain that you will learn a lot of valuable lessons from this video.
Dear Prof Devgan
Thank you for this case. I have 1 question to ask and it is about the K readings. I am currently seeing a patient who had presented with bilateral Acute Angle Closure for which PI’s could not be done successfully after multiple attempts. We decided to go for a bilateral sequential cataract extraction to break the attack starting with the worse eye. I am still assessing the patient doing multiple topography scans there is an expected decrease in pachymetry by around 100 microns (from 739 to 633 and 693 to 594) post op with normal IOP control in both eyes. She still has ongoing inflammation despite giving intracam kenalog intra-op and taildown of steroids (since the 1st operation on 11/5/22).
The results below show the lens biometry taken with the same biometer 1 week after the right cataract (temporal incision) was done. There is a significant difference between the IOL calcs
Date 10/5/2022 16/5/2022 (Pseudophakic acryclic option selected)
R1 42.60 @137 42.12 @ 148
R2 44.84 @ 47 44.13 @ 58
Ast 2.24 @ 47 2.00 @ 58
WTW 11.4 11.36
AL 22.91 22.73
CCT 739 na
AD 1.45 na
ACD 2.19 na
IOL calc 22.50D = 0.16D 24.00D = -0.07D
If you had a patient with AAC like we had, and no options like laser correction for any refractive surprises, how would you plan your surgery with this in mind, to give the patient the best possible vision with a monofocal lens. I was going to present the case to you for discussion once she settles completely but since you posted this now I decided to ask for your thoughts.
Thanks