Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (eagle): a randomised controlled trial

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EAGLE - a randomised controlled trial

www.thelancet.com Vol 388 October 1, 2016 
Eff ectiveness of early lens extraction for the treatment of 
primary angle-closure glaucoma (EAGLE): a randomised 
controlled trial
Augusto Azuara-Blanco, Jennifer Burr, Craig Ramsay, David Cooper, Paul J Foster, David S Friedman, Graham Scotland, Mehdi Javanbakht, 
Claire Cochrane, John Norrie, for the EAGLE study group
 Primary angle-closure glaucoma is a leading cause of irreversible blindness worldwide. In early-stage 
disease, intraocular pressure is raised without visual loss. Because the crystalline lens has a major mechanistic role, 
lens extraction might be a useful initial treatment.
 From Jan 8, 2009, to Dec 28, 2011, we enrolled patients from 30 hospital eye services in fi ve countries. 
Randomisation was done by a web-based application. Patients were assigned to undergo clear-lens extraction or 
receive standard care with laser peripheral iridotomy and topical medical treatment. Eligible patients were aged 
50 years or older, did not have cataracts, and had newly diagnosed primary angle closure with intraocular pressure 
30 mm Hg or greater or primary angle-closure glaucoma. The co-primary endpoints were patient-reported health 
status, intraocular pressure, and incremental cost-eff ectiveness ratio per quality-adjusted life-year gained 36 months 
after treatment. Analysis was by intention to treat. This study is registered, number ISRCTN44464607.
 Of 419 participants enrolled, 155 had primary angle closure and 263 primary angle-closure glaucoma. 
208 were assigned to clear-lens extraction and 211 to standard care, of whom 351 (84%) had complete data on health 

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