Research in context
Evidence before this study
We identifi ed a Cochrane systematic review that had not found any
relevant randomised controlled trials. We also searched the
National Research Register, Current Controlled Trials,
ClinicalTrials.gov, the WHO International Clinical Trial Registry,
MEDLINE, Embase, the Science Citation Index, Biosis, CENTRAL,
and Scopus In Press with the following terms: “glaucoma”, “angle-
closure”, “PACG”, “phacoemulsifi cation”, “lens extraction”, and
“lens removal” for papers published from inception until June 30,
2007. We updated our searches during the trial, with the last being
done in January, 2016. We found no trials assessing early (clear)
lens extraction as the primary treatment for chronic primary
angle-closure glaucoma. We identifi ed clinical trials that had
assessed interventions for primary angle-closure glaucoma, but
they studied diff erent populations (eg, patients with cataract or
after acute attacks of angle closure), lens extraction after other
treatments had failed to control the disease, or both.
Added value of this study
This large multicentre randomised controlled trial provides
evidence supporting the use of initial clear-lens extraction as a
fi rst-line intervention for primary angle-closure glaucoma and
primary angle closure with high intraocular pressure.
Implications of all the available evidence
Laser peripheral iridotomy as the initial treatment for
angle-closure glaucoma should be reconsidered. This study
provides robust evidence that initial clear-lens extraction is
associated with better clinical and patient-reported outcomes,
and that this approach is likely to be cost-eff ective in a publicly
funded health system.
Articles
www.thelancet.com Vol 388 October 1, 2016
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