ESCRS - PO001 - THE EFFECT OF LENS EXTRACTION VERSUS LASER PERIPHERAL IRIDOTOMY ON ANTERIOR SEGMENT PARAMETERS IN PATIENTS WITH PRIMARY ANGLE-CLOSURE SUSPECT

THE EFFECT OF LENS EXTRACTION VERSUS LASER PERIPHERAL IRIDOTOMY ON ANTERIOR SEGMENT PARAMETERS IN PATIENTS WITH PRIMARY ANGLE-CLOSURE SUSPECT

Published 2025 - 29th ESCRS Winter Meeting

Reference: PO001 | Type: Presented Poster & Poster | DOI: 10.82333/j4wx-q463

Authors: Muhammad M. Elsharkawy* 1 , Ahmed Sermed Al Sakini 2 , Mohamed Elnagar 1 , Alhasan Ali Al-Magsousi 2 , Ahmed kareem Al-Badiri 2 , May Ameri 3 , Mohammed A. Fenjan 4 , Mohamed Hosny 5

1Alexandria Main University Hospital ,Alexandria,Egypt, 2University of Baghdad, College of Medicine,Baghdad,Iraq, 3Department of Ophthalmology,Baylor College of Medicine, Cullen Eye Institute,Houston, Texas,United States, 4Ibn Al Haitham Teaching Eye Hospital,Baghdad,Iraq, 5Department of Ophthalmology, Cairo University Hospitals,Cairo,Egypt

Purpose

This meta-analysis compared the effects of lens extraction (LE) versus laser peripheral iridotomy (LPI) on anterior segment parameters in patients with primary angle-closure suspect (PACS), assessing multiple metrics including angle opening distance (AOD), trabecular iris space area (TISA), trabecular iris angle (TIA), iris curvature (I-CURV), trabecular-ciliary process distance (TCPD), lens vault (LV) and Mean Shaffer Gonioscopy Grading.

Setting

This Systematic review/Meta-analysis was conducted in Alexandria Faculty of Medicine, Alexandria, Egypt and University of Baghdad, College of Medicine, Baghdad, Iraq.

Methods

We searched PubMed, Scopus, Web of Science (WOS), and the Cochrane Library for studies comparing both LPI versus LE and their effects on anterior segment morphology. All study designs were eligible except for case reports and case series. Mean differences (MD), with 95% confidence intervals (CIs), were used as effect estimates for continuous outcomes. Meta-analysis was conducted using Review Manager (version 5.4), and the quality of included studies was assessed using Newcastle-Ottawa Scale (NOS) for observational studies and ROB-2 for Randomised controlled studies.

Results

Four studies were included in the analysis. On short term (1 month) and long term (2 years) of follow-up, LE showed consistently greater improvements than LPI across all metrics. At one month, AOD500 and AOD750 were significantly larger after LE (Mean Differences (MD): -0.19 mm and -0.26 mm; both p < 0.00001), with sustained effects at two years. TISA500 and TISA750 also favoured LE (mean differences: -0.07 mm² and -0.21 mm²; p < 0.00001). For TIA, LE showed a greater reduction (MD: -21.85°; p < 0.00001), while I-CURV (MD: 0.10, 95% CI:0.08-0.11) and TCPD (MD: -0.52, 95% CI: -0.54, -50) also favoured LE (p < 0.00001). LV increased more after LE (0.86 mm; p < 0.00001). Similarly, Mean Shaffer gonioscopy grading favoured LE (SMD: -2.49; p < 0.00001).

Conclusion

In conclusion, this meta-analysis underscores the critical importance of lens extraction in managing glaucoma patients, revealing that it significantly enhances anterior segment parameters compared to laser peripheral iridotomy. The consistent improvements observed across multiple time points and metrics highlight lens extraction as a more effective intervention, informing clinical decision-making and ultimately enhancing patient outcomes in glaucoma management. These findings not only reinforce the need for tailored treatment strategies but also pave the way for further research into optimizing glaucoma therapies.