Meta-Analysis of Phacoemulsification and Laser Peripheral Iridotomy in the Treatment of Primary Angle-Closure Glaucoma

Xie, Jia; Li, Pengcheng; Han, Bo

doi:https://doi.org/10.1155/2023/6732424

Journal of Ophthalmology

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Abstract Introduction Methods Results Discussion Conclusion Data Availability Conflicts of Interest References Copyright Related Articles

Research Article | Open Access

Volume 2023 | Article ID 6732424 | https://doi.org/10.1155/2023/6732424

Meta-Analysis of Phacoemulsification and Laser Peripheral Iridotomy in the Treatment of Primary Angle-Closure Glaucoma

Jia Xie,¹Pengcheng Li,¹and Bo Han¹

Academic Editor: Sudhir Patel

Received29 Sept 2022

Revised17 Feb 2023

Accepted28 Mar 2023

Published19 Apr 2023

Abstract

Background. In this meta-analysis, we aimed to systematically compare the efficacy and safety of phacoemulsification and laser peripheral iridotomy (LPI) in the treatment of primary angle-closure glaucoma (PACG). Method. We searched PubMed, MEDLINE, EMBASE, the Cochrane Library, the Chinese Journal Full-text Database (CNKI), the Wanfang database, and the China Science and Technology Journal Database for randomized controlled trials (RCTs) of phacoemulsification and LPI in the treatment of PACG published up to September 30, 2022. Postoperative intraocular pressure (IOP), anterior chamber depth (ACD), complications, corneal endothelial cell count, and best-corrected visual acuity (BCVA) were compared. The effective quantity of measurement data was measured by the mean difference (MD) and 95% confidence interval (CI). The effect of counting data was measured by the odds ratio (OR). Result. A total of 1731 potential studies were identified, and after screening, 8 RCT studies were included. The results of the meta-analysis showed that, compared to the LPI group, the patients in the phacoemulsification group showed lower IOP six and twelve months after operation (MD-3.39, 95% CI −4.15∼−2.63, ; −2.29, −3.52∼−1.06, 0.0003). The ACD in the phacoemulsification group was significantly deeper than that in the LPI group (1.59, 1.10∼2.09, 0.00001). Meanwhile, the incidence of complications in the phacoemulsification group was lower than that in the LPI group (OR = 0.46, 0.29∼0.72, 0.0006). There was no statistically significant difference between the phacoemulsification group and the LPI group in corneal endothelial cell count and BCVA at 6 and 12 months after operation (; 0.11; 0.81). Conclusion. Compared with LPI, phacoemulsification is safer and more effective in the treatment of PACG, especially in controlling IOP and minimizing postoperative complications.

1. Introduction

Glaucoma is one of the leading causes of irreversible blindness worldwide [1]. It was estimated that there were 20.2 million cases of PACG in 2013, and it was projected that this number would rise to 32.04 million in 2040 due to the anticipated increase in the aging population [2]. Although primary open-angle glaucoma (POAG) is more prevalent, PACG is more invasive and on average carries a three-fold higher risk of severe, bilateral visual impairment compared to POAG [3]. The prevalence of glaucoma varied across ethnicity, as PACG is more common in Asians [4]. Moreover, growing amounts of data from recent studies have shown that PACG is 2–4 times more prevalent than previously reported in Europe and the USA [2, 5]. Therefore, it is particularly important to choose the appropriate PACG therapy and treatment.

LPI is commonly performed on PACG patients to relieve pupil blockage. LPI, however, is unable to open the closed anterior chamber angle in up to 58% of PACG patients [6, 7].

Cataract phacoemulsification has improved in recent years due to the development of phacoemulsification and a more reliable fluid flow system [8]. The indications for cataract surgery have been expanded to include the treatment of eye diseases other than cataracts due to improvements in surgical safety. Currently, a growing number of studies indicate that cataract extraction can play a significant role in decreasing IOP and minimizing the application of glaucoma medicines [9–21].

2. Methods

2.1. Literature Search

Two researchers independently searched the electronic databases such as PubMed, Medline, EMBASE, Cochrane Library, CNKI, Wanfang database, and China Science and Technology Journal Database until September 30^th 2022 for studies of RCTs of phacoemulsification and LPI in the treatment of PACG with the following terms: randomized controlled trial, controlled clinical trial, randomized, placebo, randomly, trial, groups, iridotomy, peripheral iridotomy, laser peripheral iridotomy, primary angle closure, angle-glosure glaucoma, angle-closure glaucomas, glaucomas angle closure, glaucoma uncompensated, glaucomas uncompensated, uncompensated glaucoma, ucompensated glaucomas, glaucoma closed-angle, closed-angle glaucoma, closed-angle glaucomas, glaucoma closed angle, glaucomas closed-angle, glaucoma uncompensative, glaucomas uncompensative, uncompensative glaucomas, uncompensative glaucoma, glaucoma angle closure, angle closure glaucoma, angle closure glaucomas, glaucomas angle closure, glaucoma narrow-angle, glaucoma narrow angle, glaucomas narrow-angle, narrow-angle glaucoma, narrow-angle glaucomas, cataract extractions, extraction cataract, extractions cataract, phakectomy, phakectomies, enzymatic zonulolysis, enzymatic zonulolyses, zonulolyses enzymatic, zonulolysis enzymatic, capsulorhexis, and phacoemulsification.

2.2. Inclusion and Exclusion Criteria

Studies were included if they met the following criteria: (1) the RCT study of patients with PACG; (2) interventions only included phacoemulsification and LPI; and (3) studies published in Chinese or English.

Studies were excluded if they met the following criteria: (1) they were not RCT studies; (2) studies contained other interventions in addition to phacoemulsification and LPI; (3) studies published in languages other than Chinese or English; and (4) studies with incomplete resources, insufficient data, or lack of author information.

2.3. Data Extraction

The relevant data from the articles were extracted by two researchers independently according to the designed data extraction table. The specific information includes the following: (1) general characteristics of the study: including author, publication time, and publication journal; (2) the general characteristics of the subjects included in the study; (3) intervention measures, outcome indicators, etc; and (4) statistical methods of research. Inconsistencies and differences of opinion in the process of extracting data shall be solved through joint discussion with the third researcher.

2.4. Assessment of Study Quality

The two researchers independently evaluated the quality of the selected studies according to the evaluation criteria. In case of disagreement, it shall be solved through discussion or by inviting a third researcher. The quality of the RCT study was evaluated by the Cochrane bias risk tool according to the following seven domains: (1) random sequence generation (selection bias); (2) allocation concealment (selection bias); (3) blinding of participants and personnel (implementation bias); (4) blinding of outcome assessment (measurement bias); (5) incomplete outcome data (follow-up bias); (6) selective reporting of research results (reporting bias); and (7) other bias. Each domain was graded into “low risk of bias,” “high risk of bias,” or “unclear risk of bias.”

2.5. Statistical Analysis

All analyses were performed with the RevMan5.4 software. The heterogeneity among studies was evaluated by the Q test and I² test. For the studies with significant heterogeneity ( or I² > 50%), the random effect model was used for analysis. When significant heterogeneity existed, sensitivity analysis was used to eliminate studies with large differences or studies with a high risk of bias to test the stability of the combined results. For studies with low heterogeneity ( or I² < 50%), the fixed effect model was used for analysis. IOP, ACD, corneal endothelial cell counting, and BCVA were measured. The mean difference (MD) and 95% confidence interval (CI) were used as statistical analysis variables. The complications during treatment were binary variables, using the odds ratio (OR) and 95% CI as statistical analysis variables. A value less than 0.05 was considered to be statistically significant.

3. Results

3.1. Search Results

A total number of 1731 potential studies were identified from an electronic-based search, of which 1570 studies remained after eliminating duplicates. Fifty-four studies remained after analyzing the titles and abstracts of the studies and removing any with inconsistent content or incomplete main indicators. Fifty-four full-text articles were identified as potentially relevant for analysis in terms of the inclusion and exclusion criteria. Finally, eight studies [22–29] involving 894 eyes were included in the analysis. There was no significant difference in age, gender composition ratio, and IOP before treatment between the two groups (). The article screening process is shown in Figure 1, and the basic information of the included studies is shown in Table 1.

3.2. The Characteristics of the Included Studies

The 8 included studies were all RCTs. The Cochrane Risk of Bias Assessment Tool was used to assess the quality and bias risk of the included RCTs. The results are displayed in Figure 2. Six studies [23, 25–29] mentioned the random sequence generation scheme, indicating a low risk of bias. Two studies [22, 24] were rated as uncertain because the random sequence generation scheme was not specified in the text. Among the selection bias related to allocation concealment, four studies [22–25] did not report it in the paper, so the risk of bias was uncertain. In the implementation bias, two studies [22, 24] could not judge the bias risk, and one study [22] was evaluated as high risk in reporting the source of bias. Among measurement bias, follow-up bias, and other biases, all studies [22–29] were determined as low risk.

(a)

(b)

3.3. Meta-Analysis Results

3.3.1. IOP at Different Times after the Operation

A total of three studies [24, 27, 29] recorded the IOP values of the two groups six months after treatment. Because no statistical heterogeneity was found among the studies ( and I² = 0%), we used the fixed effect model for analysis. The results showed that the IOP six months after operation in the phacoemulsification group was significantly lower than that in the LPI group, and the difference was statistically significant (MD-3.39, 95% CI −4.15∼−2.63, and ; Figure 3(a)).

(a)

(b)

(c)

A total of three studies [26, 27, 29] recorded the IOP values of the two groups of patients twelve months after treatment. There was significant heterogeneity between the studies ( and I² = 52%), so the random effect model was used for analysis. The results showed that the IOP 12 months after operation in the phacoemulsification group was significantly lower than that in the LPI group, and there was statistically significant difference (MD-2.29, 95% CI −3.52∼−1.06, and ; Figure 3(b)). A sensitivity analysis was conducted for the heterogeneity among studies, and the results showed that the heterogeneity decreased significantly and the combined effect value did not change significantly (I² = 0%, MD-2.63, 95% CI −3.31 ∼ −1.95, ; Figure 3(c)) after excluding the study of Husain et al. [26]. It showed that the results of the meta-analysis were stable.

3.3.2. ACD after the Operation

A total of four studies [22, 23, 25, 28] recorded the ACD of the two groups three months after the operation. There was significant heterogeneity between the studies ( and I² = 99%), so the random effect model was used for analysis. The results showed that the central ACD in the phacoemulsification group was significantly deeper than that in the LPI group three months after the operation, and there was statistically significant difference (MD 1.59, 95% CI 1.10∼2.09, and ). A sensitivity analysis was conducted for the heterogeneity among studies, and the results showed that the heterogeneity decreased significantly and the combined effect value did not change significantly (I² = 0%, MD 1.79, 95% CI 1.72∼1.86, and ) after excluding the study of Min et al. [22]. It showed that the meta-analysis results were stable (Figure 4).

(a)

(b)

3.3.3. Probability of Complications during Treatment

A total of three studies [24, 26, 29] recorded the complications during postoperative treatment. There was no significant heterogeneity between the studies ( and I² = 0%), so the fixed effect model was used for analysis. The results showed that the incidence of complications in the phacoemulsification group was significantly lower than that in the LPI group, and the difference was statistically significant (OR = 0.46, 95% CI 0.29∼0.72, and ; Figure 5).

3.3.4. Corneal Endothelial Cell Counting after the Operation

A total of two studies [24, 26] recorded corneal endothelial cell counting of the two groups six months after the operation. There was no significant heterogeneity between the studies ( and I² = 0%), so the fixed effect model was used for analysis. The results showed that there was no significant difference in corneal endothelial cell counting between the two groups six months after the operation (, Figure 6).

3.3.5. BCVA after the Operation

A total of two studies [26, 27] recorded the BCVA of the two groups six months after the operation. There was no significant heterogeneity between the studies ( and I² = 0%), so the fixed effect model was used for analysis. The results showed that there was no significant difference in the BCVA six months after the operation between the two groups (, Figure 7(a)).

(a)

(b)

A total of two studies [27, 29] recorded the BCVA of the two groups of patients twelve months after the operation. There was no significant heterogeneity between the studies ( and I² = 0%), so the fixed effect model was used for analysis. The results showed that there was no significant difference in the BCVA twelve months after operation between the two groups (, Figure 7(b)).

4. Discussion

In PACG, the relative pupillary block is a common mechanism that contributes to the closure of the anterior chamber angle, but it is not the only mechanism. According to the World Glaucoma Expert Consensus, [30] the mechanism for angle closure in PACG primarily involves four elements: the iris, ciliary body, lens, and posterior lens. Some patients experience multiple factors contributing to their condition, and lens-related factors play a role in all the mechanisms except the one at the ciliary body level, highlighting the significance of the lens in the pathogenesis of glaucoma.

A multicenter research indicated that clear lens extraction showed greater efficacy and should be considered to be the first-line treatment of PACG [29]. Although phacoemulsification has been used to treat PACG in China 20 years ago, [31] some domestic scholars disagree that clear lens extraction is the first choice for PACG. They believe that LPI can relieve pupil block. As a result, there is no reason to remove the normal lens. It has been suggested that, as an internal eye surgery, the risk of cataract phacoemulsification is higher than that of LPI, there may be more complications, and the visual function of patients may be dramatically worse than before. How should we select a PACG treatment?

Firstly, in most PACG cases, there are some pathological changes even when there is no obvious lens opacity. In these patients, the lens is generally thicker or positioned too far forward, which is a significant pathological mechanism leading to angle closure. Lens extraction can theoretically eliminate the anatomical factors that contribute to this closure. In recent years, several clinical trials have demonstrated that cataract extraction can significantly broaden the anterior chamber angle [32–37]. By comparing ACD between the two groups after treatment, we observed that the ACD in the phacoemulsification group was significantly deeper than that in the LPI group, and the difference was statistically significant, which was consistent with the above research results. These findings confirmed that phacoemulsification could effectively deepen the anterior chamber and inhibit the mechanism of angle closure.

Secondly, our study found that there was no significant difference in corneal endothelial cell count between the two groups six months after treatment (), indicating that, despite being an internal eye operation, cataract phacoemulsification did not cause additional endothelial cell damage compared to the LPI group. With the advancement of modern cataract phacoemulsification technology and the protection provided by viscoelastic agents, the impact of cataract surgery on the corneal endothelium has been gradually reduced. The results revealed that the occurrence of complications was lower in the phacoemulsification group than that in the LPI group, and the difference was statistically significant (). It further proves that phacoemulsification is a safe and effective treatment option for PACG.

At the same time, phacoemulsification has more advantages than LPI in terms of IOP control. At six and twelve months after the operation, the IOP in the phacoemulsification group was lower than that in the LPI group, and the difference was statistically significant.

Finally, this study analyzed the BCVA of the two groups six and twelve months after treatment. The results showed that there was no significant difference in BCVA between the two groups (), indicating that there were no complications affecting visual acuity in the phacoemulsification. It demonstrated that phacoemulsification did not increase the risk of visual loss while maintaining good IOP control. This further suggests that phacoemulsification is expected to be the first choice for the treatment of angle closure glaucoma.

5. Conclusion

Based on the above evidence, cataract phacoemulsification may be a crucial surgical option for the treatment of PACG. Phacoemulsification is more effective than LPI for PACG treatment, particularly in controlling IOP and minimizing complications. However, there are few studies that have examined the effectiveness of the two treatments over the long term. Therefore, additional research is required for long-term follow-up observation to evaluate its safety and validate the advantages already observed so far.

Data Availability

The data used to support the findings of this study are included within the article.

Conflicts of Interest

The authors declare that there are no potential conflicts of interest.

References

WHO, “Global data on visual impairments 2010,” Tech. Rep., World Health Organization, Geneva, Switzerland, 2012, WHO/NMH/PBD/12.01.
View at: Google Scholar
Y. C. Tham, X. Li, T. Y. Wong, H. A. Quigley, T. Aung, and C. Y. Cheng, “Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis,” Ophthalmology, vol. 121, no. 11, pp. 2081–2090, 2014.
View at: Publisher Site | Google Scholar
D. S. Friedman, P. J. Foster, T. Aung, and M. He, “Angle closure and angle-closure glaucoma: what we are doing now and what we will be doing in the future,” Clinical and Experimental Ophthalmology, vol. 40, no. 4, pp. 381–387, 2012.
View at: Publisher Site | Google Scholar
L. Wang, W. Huang, S. Huang et al., “Ten-year incidence of primary angle closure in elderly Chinese: the Liwan Eye Study,” British Journal of Ophthalmology, vol. 103, no. 3, pp. 355–360, 2019.
View at: Publisher Site | Google Scholar
A. C. Day, G. Baio, G. Gazzard et al., “The prevalence of primary angle closure glaucoma in European derived populations: a systematic review,” British Journal of Ophthalmology, vol. 96, no. 9, pp. 1162–1167, 2012.
View at: Publisher Site | Google Scholar
M. Baskaran, E. Yang, S. Trikha et al., “Residual angle closure one year after laser peripheral iridotomy in primary angle closure suspects,” American Journal of Ophthalmology, vol. 183, pp. 111–117, 2017.
View at: Publisher Site | Google Scholar
G. Kumar, S. J. Bali, A. Panda, A. Sobti, and T. Dada, “Prevalence of plateau iris configuration in primary angle closure glaucoma using ultrasound biomicroscopy in the Indian population,” Indian Journal of Ophthalmology, vol. 60, no. 3, pp. 175–178, 2012.
View at: Publisher Site | Google Scholar
G. Davis, “The evolution of cataract surgery,” Missouri Medicine, vol. 113, no. 1, pp. 58–62, 2016.
View at: Google Scholar
D. T. Barbosa, A. L. Levison, and S. C. Lin, “Clear lens extraction in angle-closure glaucoma patients,” International Journal of Ophthalmology, vol. 6, no. 3, pp. 406–408, 2013.
View at: Publisher Site | Google Scholar
R. H. Brown, L. Zhong, and M. G. Lynch, “Clear lens extraction as treatment for uncontrolled primary angle-closure glaucoma,” Journal of Cataract and Refractive Surgery, vol. 40, no. 5, pp. 840-841, 2014.
View at: Publisher Site | Google Scholar
R. H. Brown, L. Zhong, and M. G. Lynch, “Lens-based glaucoma surgery: using cataract surgery to reduce intraocular pressure,” Journal of Cataract and Refractive Surgery, vol. 40, no. 8, pp. 1255–1262, 2014.
View at: Publisher Site | Google Scholar
P. P. Chen, S. C. Lin, A. K. Junk, S. Radhakrishnan, K. Singh, and T. C. Chen, “The effect of phacoemulsification on intraocular pressure in glaucoma patients: a report by the American Academy of Ophthalmology,” Ophthalmology, vol. 122, no. 7, pp. 1294–1307, 2015.
View at: Publisher Site | Google Scholar
S. Moghimi, F. Bijani, R. Chen et al., “Anterior segment dimensions following laser iridotomy in acute primary angle closure and fellow eyes,” American Journal of Ophthalmology, vol. 186, pp. 59–68, 2018.
View at: Publisher Site | Google Scholar
M. L. Napier and A. Azuara-Blanco, “Changing patterns in treatment of angle closure glaucoma,” Current Opinion in Ophthalmology, vol. 29, no. 2, pp. 130–134, 2018.
View at: Publisher Site | Google Scholar
A. Nonaka, T. Kondo, M. Kikuchi et al., “Cataract surgery for residual angle closure after peripheral laser iridotomy,” Ophthalmology, vol. 112, no. 6, pp. 974–979, 2005.
View at: Publisher Site | Google Scholar
M. R. Razeghinejad and J. S. Myers, “Contemporary approach to the diagnosis and management of primary angle-closure disease,” Survey of Ophthalmology, vol. 63, no. 6, pp. 754–768, 2018.
View at: Publisher Site | Google Scholar
T. V. Roberts, I. C. Francis, S. Lertusumitkul, M. B. Kappagoda, and M. T. Coroneo, “Primary phacoemulsification for uncontrolled angle-closure glaucoma,” Journal of Cataract & Refractive Surgery, vol. 26, no. 7, pp. 1012–1016, 2000.
View at: Publisher Site | Google Scholar
C. C. Tham, Y. Y. Kwong, D. Y. Leung et al., “Phacoemulsification versus combined phacotrabeculectomy in medically controlled chronic angle closure glaucoma with cataract,” Ophthalmology, vol. 115, no. 12, pp. 2167–2173, 2008.
View at: Publisher Site | Google Scholar
C. C. Tham, Y. Y. Kwong, D. Y. Leung et al., “Phacoemulsification versus combined phacotrabeculectomy in medically uncontrolled chronic angle closure glaucoma with cataracts,” Ophthalmology, vol. 116, no. 4, pp. 725–731, 2009.
View at: Publisher Site | Google Scholar
T. Shao, J. Hong, J. Xu, Q. Le, J. Wang, and S. Qian, “Anterior chamber angle assessment by anterior-segment optical coherence tomography after phacoemulsification with or without goniosynechialysis in patients with primary angle closure glaucoma,” Journal of Glaucoma, vol. 24, no. 9, pp. 647–655, 2015.
View at: Publisher Site | Google Scholar
P. N. Shams and P. J. Foster, “Clinical outcomes after lens extraction for visually significant cataract in eyes with primary angle closure,” Journal of Glaucoma, vol. 21, no. 8, pp. 545–550, 2012.
View at: Publisher Site | Google Scholar
M. Fang, Y. Q. Hu, C. L. Chen, and H. B. Cheng, “Surgery in early primary angle closure glaucoma with cataract,” Guoji Yanke Zazhi, vol. 12, no. 5, pp. 926-927, 2012.
View at: Google Scholar
X. H. Zhang, S. H. Zhang, Y. Q. Chen, and L. H. Chen, “Effect of lens extraction on primary angle closure glaucoma complicated with cataract,” Contemporary Medicine, vol. 19, no. 34, pp. 115-116, 2013.
View at: Google Scholar
Q. H. Kong, X. Y. Dou, and J. Guo, “Clinical observation of primary phacoemulsification plus intraocular lens implantation for primary angle-closure glaucoma,” Guoji Yanke Zazhi, vol. 13, no. 9, pp. 1807–1809, 2013.
View at: Google Scholar
J. N. Wang, “Phacoemulsification and phacoemulsification in the treatment of primary angle closure glaucoma complicated with cataract,” Henan Medical Research, vol. 26, no. 18, pp. 3360-3361, 2017.
View at: Google Scholar
R. Husain, G. Gazzard, T. Aung et al., “Initial management of acute primary angle closure: a randomized trial comparing phacoemulsification with laser peripheral iridotomy,” Ophthalmology, vol. 119, no. 11, pp. 2274–2281, 2012.
View at: Publisher Site | Google Scholar
D. S. Lam, D. Y. Leung, C. C. Tham et al., “Randomized trial of early phacoemulsification versus peripheral iridotomy to prevent intraocular pressure rise after acute primary angle closure,” Ophthalmology, vol. 115, no. 7, pp. 1134–1140, 2008.
View at: Publisher Site | Google Scholar
A. Dias-Santos, J. Ferreira, L. Abegão Pinto et al., “Phacoemulsification versus peripheral iridotomy in the management of chronic primary angle closure: long-term follow-up,” International Ophthalmology, vol. 35, no. 2, pp. 173–178, 2015.
View at: Publisher Site | Google Scholar
A. Azuara-Blanco, J. Burr, C. Ramsay et al., “Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial,” The Lancet, vol. 388, no. 10052, pp. 1389–1397, 2016.
View at: Publisher Site | Google Scholar
N. L. Wang, R. Y. Wu, H. P. Yuan et al., “Consensus series of the World federation of glaucoma societies (translated version),” Chinese Medical Journal, vol. 51, no. 11, p. 113, 2016.
View at: Google Scholar
J. Ge, Y. Guo, Y. Z. Liu et al., “Preliminary clinical observation of phacoemulsification and cataract extraction in the treatment of angle closure glaucoma,” Chinese Journal of Ophthalmology, vol. 37, no. 5, pp. 355–358, 2001.
View at: Google Scholar
Y. Zhang, S. Z. Li, L. Li, M. G. He, R. Thomas, and N. L. Wang, “Quantitative analysis of iris changes after physiologic and pharmacologic mydriasis in a rural Chinese population,” Investigative Ophthalmology & Visual Science, vol. 55, no. 7, p. 4405, 2014.
View at: Publisher Site | Google Scholar
Y. Zhang, S. Z. Li, L. Li, M. G. He, R. Thomas, and N. L. Wang, “Dynamic iris changes as a risk factor in primary angle closure disease,” Investigative Ophthalmology & Visual Science, vol. 57, no. 1, p. 218, 2016.
View at: Publisher Site | Google Scholar
Y. Zhang, S. Z. Li, L. Li, M. G. He, R. Thomas, and N. L. Wang, “Quantitative analysis of iris changes following mydriasis in subjects with different mechanisms of angle closure,” Investigative Ophthalmology & Visual Science, vol. 56, no. 1, pp. 563–570, 2015.
View at: Publisher Site | Google Scholar
X. D. Song, N. L. Wang, G. X. Tang et al., “Multicentre trial of phacoemulsification on patients with primary angle-closure glaucoma and coexisting cataract,” Journal of medical research, vol. 39, no. 3, pp. 17–22, 2010.
View at: Google Scholar
Y. B. Liang, N. L. Wang, L. Y. Qiao, and X. D. Song, “To evaluate the efficacy of simple cataract surgery in the treatment of angle closure glaucoma complicated with cataract,” Chinese Journal of Ophthalmology, vol. 40, no. 11, pp. 723–725, 2004.
View at: Google Scholar
L. Y. Qiao, Y. B. Liang, N. L. Wang, S. Y. Zhan, H. E. Wang, and Z. H. Wu, “The systematic review of the cataract extraction for primary angle-closure glaucoma coexisting cataract,” Ophthalmol CHN, vol. 14, no. 2, pp. 93–98, 2005.
View at: Google Scholar

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Copyright © 2023 Jia Xie et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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