Clear lens extraction for the management of primary angle closure glaucoma: surgical technique and refractive outcomes in the EAGLE cohort

Background/Aims:
To describe the surgical technique and refractive outcomes following clear lens extraction (CLE) in the EAGLE trial.
Methods:
Review of prospectively collected data from a multicentre, randomised controlled trial. comparing CLE and laser peripheral iridotomy. Eligible participants were ≥50 years old, and newly diagnosed with (1) primary angle-closure (PAC) with intraocular pressure (IOP) above 30 mmHg, or (2) primary angle-closure glaucoma (PACG). We report the postoperative corrected distance visual acuity (CDVA), and refractive outcomes at 12 and 36 months postoperatively for those who underwent CLE.
Results:
Of the 419 participants, 208 were randomised to CLE. Two patients (2/208, 1.0%, 95% CI: 0.04 to 3.67%) had posterior capsule rupture requiring anterior vitrectomy and sulcus IOL placement. Mean baseline CDVA was 77.9 (SD 12.4) ETDRS letters and did not change significantly at 36 months, 79.9 (SD 10.9) letters. Mean preoperative spherical equivalent was +1.7 (SD 2.3) and +0.08 (SD 0.95) diopters (D) at 36 months. Fifty-nine percent and 85% eyes were within ±0.5D and ±1.0D of predicted refraction respectively at 36 months.
Conclusions:
Mean CDVA in patients undergoing clear lens extraction for angle-closure glaucoma appeared stable over the 3 year study period. Refractive error was significantly reduced with surgery but refractive predictability was sub-optimal.