A Prospective Interventional Study to Study Changes in Intra Ocular Pressure (IOP) after Phacoemulsification in Patients with Cataract and Primary Angle Closure Suspect, Primary Angle Closure or Primary Angle Closure Glaucoma

Title: "A Prospective Interventional Study to Study Changes in Intra Ocular Pressure (IOP) after Phacoemulsification in Patients with Cataract and Primary Angle Closure Suspect, Primary Angle Closure or Primary Angle Closure Glaucoma". Material and methods: A prospective, nonrandomized, non-comparative, interventional study conducted on primary angle closure patients attending the outpatient department of Rotary eye institute, Navsari, Gujarat, India from August 2020 to august 2021 i.e., 12 months of duration. Patients were registered with their name, age, sex, occupation and postal address. Each patient included in the study underwent history taking including past history of any laser treatment or surgeries and complete ophthalmological examination including: Uncorrected distance visual acuity (UCVA), best corrected distance visual acuity (BCVA) measurement, Slit lamp biomicroscopic examination, Fundus examination using Indirect ophthalmoscope, Central corneal thickness using Pachymetry, Keratometry using autokeratometer, A scan Biometry for Axial length, Anterior chamber depth, Lens thickness, IOP measurement using Goldmann Applanation tonometer and Shaeffer?s grading for further gonioscopic scoring was done from 0-16 by adding all the angle grades, Gonioscopy to detect type of glaucoma. And evaluated preoperative and postoperative changes in uncorrected and best corrected visual acuity, intraocular pressure (IOP). Results: 50 eyes were taken in this study. 54% were found to be females and 46% were found to be males among 50 patients in my study. Visual outcomes were noted after phacoemulsification surgery in these patients which showed significant improvement in UCVA as well as BCVA after surgery In preoperative period, 8 patients had UCVA between 6/6-6/18, 22 patients had UCVA between 6/18-6/60 and 20 patients had UCVA less than6/60. In post operative period, 38 patients had UCVA between 6/6-6/18, 12 patients had UCVA between 6/18-6/60 and 0 patient had UCVA less than6/60. In preoperative period, 26 patients had BCVA between 6/6-6/18, 13 patients had BCVA between 6/18-6/60 and 11 patients had BCVA less than6/60. In post operative period, 46 patients had BCVA between 6/6-6/18, 4 patients had BCVA between 6/18-6/60 and 0 patient had BCVA less than6/60. In 50 eyes, mean baseline IOP was 26 mmHg (mean IOP). Mean IOP after 1 week of phacoemulsification was 16 mmHg, Mean IOP after 4 weeks was 14 mmHg and it was 15 mmHg after 3 months which was comparable with that of 4 weeks post operative IOP. Phacoemulsification for the treatment of primary angle-closure glaucoma along with cataract effectively reduces the intraocular pressure and improves their visual acuity level. The effective rate of the treatment is high, so the treatment improves the quality of life of patients. Therefore, this treatment can be used as a first line of management in patients with primary angle closure suscept, primary angle closure and primary angle closure glaucoma patients having cataract. Conclusion: Phacoemulsification is effective as therapy in close angle glaucoma with cataract by lowering IOP and also improving visual acuity. Phacoemulsification is a good alternative to other treatment modalities for angle closure glaucoma patients to lower IOP and disease progression.