Cataract Surgery in Primary Angle Closure

Angle closure is the fundamental pathology of primary angle-closure glaucoma (PACG), a spectrum of disease which is preventable if the angle-closure process can be alleviated in the early stages. Treatments to open the angle, such as laser peripheral iridotomy (LPI) and/or iridoplasty, as well as cataract extraction, are proving their effectiveness as PACG treatments. Cataract surgery in patients with angle closure is not only to restore vision but to eliminate a narrow angle, which helps to prevent or delay disease progression. However, performing cataract surgery in PAC/PACG is a complicated, challenging procedure. Patients with angle closure scheduled for cataract surgery need thorough pre- and postoperative evaluation with a good surgical plan. The IOL calculation and selection in the setting of PAC/PACG must be defined preoperatively. In cases of a preexisting functional filtration bleb, a 6-month interval between the filtering surgery and cataract surgery is recommended to maintain the bleb’s functions. Phacoemulsification and foldable IOL implantation through a temporal clear corneal incision is a good option to minimize the bleb’s manipulation. Recent advances in glaucoma surgery, such as MIGS and goniosynechialysis, can be combined with cataract surgery in mild to moderate glaucoma, due to the modest effects, compared to standard glaucoma surgery. Further investigation should be conducted to evaluate the safety and efficacy of MIGS in the setting of PACG.