PHACOEMULSIFICATION AFTER LASER PERIPHERAL IRIDOTOMY IN ACUTE PRIMARY ANGLE CLOSURE: DOES LENS EXTRACTION IMPROVE SIX-MONTH INTRAOCULAR PRESSURE CONTROL?

Acute primary angle closure (APAC) is an ophthalmic emergency requiring rapid intraocular pressure (IOP) control. Laser peripheral iridotomy (LPI) relieves pupillary block but does not address lens-related angle crowding. We compared six-month outcomes after LPI alone with those after LPI followed by early phacoemulsification. Fifty eyes of 50 patients treated for APAC between January 2019 and May 2025 were reviewed retrospectively. All eyes received IOP-lowering medical treatment followed by Nd:YAG LPI within 24 to 36 hours of admission. Group A (n = 25) received LPI alone; Group B (n = 25) underwent phacoemulsification with intraocular lens implantation at day 7. Visual acuity, IOP, gonioscopic angle width, anterior chamber depth (ACD), medication burden, therapeutic response and complications were assessed. At six months, mean IOP was 24.01 ± 3.60 mmHg in Group A and 15.32 ± 0.68 mmHg in Group B, reductions of 46.18 % and 66.05 % (p < 0.001). An optimal response (IOP < 22 mmHg, with or without medication) was recorded in 32 % and 76 % of eyes (p = 0.004) and treatment failure in 52 % and 16 % (p = 0.016). Mean LogMAR acuity improved from 1.530 to 0.972 and from 1.650 to 0.693. ACD increased from 1.90 ± 0.20 mm to 3.20 ± 0.30 mm in Group B but was unchanged in Group A; angle widening was sustained only after lens extraction. Phacoemulsification seven days after LPI was associated with better six-month IOP control and greater anatomical opening of the angle than LPI alone.