ORIGINAL STUDY
Changes in Intraocular Pressure and Angle Status After
Phacoemulsification in Primary Angle Closure Hypertension
Harathy Selvan, MD, Dewang Angmo, MD, DNB, FRCS, FICO, MNAMS,
Ankit S. Tomar, MD, Suresh Yadav, M(Optom), Arpit Sharma, MBBS,
and Tanuj Dada, MD
Purpose: To study the change in intraocular pressure (IOP) and
angle status after phacoemulsification in a cohort of primary angle
Downloaded from http://journals.lww.com/glaucomajournal by BhDMf5ePHKbH4TTImqenVGLGjjqParD6N8cPlV8+Q77HUnAvsNK7EoWU+ADp7r0VXRMus1po+YY= on 02/08/2019
closure hypertension (PACHT) patients.
Setting: Tertiary Eye Care, India.
Design: Prospective interventional case-series.
Methods: Case-series of 18 eyes of 18 patients. Preoperative biometry
including axial length, anterior chamber depth (ACD), lens thickness,
and central corneal thickness were studied. Preoperative and post-
operative IOP, number of topical glaucoma medications, angle swept
source optical coherence tomography (SS-OCT) parameters of nasal
and temporal angle opening distance, trabecular iris space area,
scleral spur angle, lens vault and circumferential iridotrabecular
contact (ITC) were studied and their correlations derived.
Results: The mean preoperative IOP, 31 ± 6 mm Hg, decreased to
14 ± 1 mm Hg at 6-months postoperative period, P < 0.001, a fall
by 58 ± 14%. The number of glaucoma medications reduced from
4(3-5) to 2(1-3), P < 0.001. All SS-OCT studied parameters denoted
significant angle widening postsurgery. The ITC % reduced from 52
(16-100) to 19(0-97), P < 0.001. The preoperative ITC showed
moderate to strong correlation with all preoperative nasal and
temporal angle parameters. It also showed moderate positive corre-
lation with percentage fall in IOP at 1-month postoperative period.
The preoperative ACD showed significant negative correlation with
preoperative and postoperative ITC.
Conclusions: PACHT patients benefit significantly from cataract
surgery with marked angle widening, IOP reduction and a decrease
in the number of glaucoma medications. The SS-OCT derived cir-
cumferential iridotrabecular contact index can be used as the single
best parameter to indicate the preoperative angle status and predict
postoperative change in IOP, as against the numerous single section
measured angle parameters.
Key Words: swept-source angle optical coherence tomography,
iridotrabecular contact, primary angle closure hypertension,
phacoemulsification
(J Glaucoma 2019;28:105–110)
P rimary angle closure disease (PACD) constitutes a spectrum
of varying disease severity, ranging from mere suspect to
established angle closure glaucoma.1 Various classifications have
Received for publication July 18, 2018; accepted November 15, 2018.
From the Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All
India Institute of Medical Sciences, New Delhi, India.
Disclosure: The authors declare no conflict of interest.
Reprints: Dewang Angmo, MD, DNB, FRCS, FICO, MNAMS, Dr.
Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of
Medical Sciences, New Delhi 110029, India (e-mail: dewang45@gmail.
com).
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
DOI: 10.1097/IJG.0000000000001137
J Glaucoma  Volume 28, Number 2, February 2019
Copyright r 2018 Wolters Kluwer Health, Inc. All rights reserved.
been proposed, and one among them introduced the term “angle
closure hypertension” to refer to patients with angle closure and
high intraocular pressure (IOP) in the absence of glaucomatous
optic nerve head (ONH) and visual field changes.2 This group of
patients are frequently met with in routine glaucoma practice,
and disregarding their IOP because of the presence of a healthy
ONH may end up in progression. In fact, 20% of treated pri-
mary angle closure hypertension (PACHT) eyes are known to
progress to primary angle closure glaucoma (PACG).3
Lens extraction for PACD is a topic of growing
interest, yet with unsettled conclusions. The ample research
available on this topic is primarily focused on PACG, or
poorly categorized PACD.4–8 Hence, we decided to review
and put forth the changes occurring postcataract surgery in
PACHT subgroup of PACD.
The standard practice for clinical diagnosis of angle
closure is by gonioscopy. However, it is a contact procedure,
requires considerable experience and is subjective. The
recent noncontact diagnostic modalities such as Anterior
Segment Optical Coherence Tomography (ASOCT) with
the angle module help in objective assessment of angle and
their quantification. A step ahead is the Swept-Source (SS)
ASOCT, in which 3-Dimensional angle analysis is possible,
which computes percentage of circumferential irido-
trabecular contact (ITC), shown to have good diagnostic
ability in picking up angle closure.9,10 Changes in the
anterior chamber and angle parameters postiridotomy and
postcataract surgery have been widely studied on Time-
Domain and Fourier-Domain OCT (Visante, Carl Zeiss
Meditec, Dublin, CA).11,12 Kasai et al13 studied angle
changes using SSOCT, however, ITC was not looked at.
Very few studies have characterized angle changes postir-
idotomy and postcataract surgery using SSOCT and cir-
cumferential ITC.14,15 Our study adds to these by relating
their clinical bearing on intraocular pressure changes post-
cataract surgery.
METHODS
It is a case series of 18 eyes of 18 patients. PACHT was
defined by the presence of shallow anterior chamber (AC)
with Van-Herick grade 1-2, an occludable angle ± synechial
angle closure of at least 180 degrees on indentation gonio-
scopy, IOP ≥ 22 mm Hg on 2 different occasions, ONH cup-
disc ratio (CDR) ≤ 0.6 with healthy rim and normal visual
fields. PACHT patients with immature senile nuclear scle-
rosis ≥ grade II were included.16 We adhered to the tenets of
Declaration of Helsinki and a written informed consent was
obtained from all the study participants. Ethical clearance
was obtained from our Institutional Ethics Committee.
All cases were assessed by preoperative Snellen visual
acuity chart, slit-lamp biomicroscopy, Goldmann applanation
www.glaucomajournal.com | 105
Selvan et al J Glaucoma  Volume 28, Number 2, February 2019

tonometry, indentation gonioscopy, optical biometry (Len-

star, LS900, Haag-Streit Diagnostics) inclusive of axial length TABLE 1. Summary of Overall Characteristics (n = 18)
(AL), keratometry, anterior chamber depth (ACD), lens Mean ± SD/Median
thickness (LT), central corneal thickness (CCT) and anterior Sl No Variable (Range)
segment swept source optical coherence tomography (SS- 1 Age (y) 57 ± 10
OCT) (SS-1000, CASIA, Tomey Corporation, Nagoya, 2 Axial length (mm) 22.08 ± 0.68
Japan) in angle analysis mode under standard dark room 3 Anterior chamber depth (mm) 2.49 ± 0.46
conditions by a single operator. The parameters of lens posi- 4 Lens thickness (mm) 4.44 ± 0.41
tion (LP = ACD+1/2LT), relative lens position (RLP = LP/ 5 Lens thickness/axial length 0.20 ± 0.01
AL) and LT/AL were further derived at. The AS-OCT 6 Lens vault (mm) 0.75 ± 0.22
parameters of nasal and temporal angle opening distance 7 Preoperative ITC (%) 52 (16-100)
(AOD500, AOD750), trabecular iris space area (TISA500, 8 Central corneal thickness (µ) 537 ± 38
9 Lens position (mm) 4.58 ± 0.80
TISA750), scleral spur angle (SSA), lens vault (LV) were 10 Relative lens position 0.20 ± 0.03
calculated from the 0 to 180 degrees SS-OCT section in all 11 Preoperative IOP (mm Hg) 31 ± 6
eyes. Being a 360 degrees angle OCT, the scleral spur and 12 Postoperative IOP at 1 mo 14 ± 3
iridotrabecular end-points were manually marked in 128 (mm Hg)
frames by a single observer (DA) and the software computed 13 % change in IOP at 1 mo 53 ± 10
ITC index and invisible range were noted down.17 If the
IOP indicates intraocular pressure.
patient was on a prostaglandin analogue, it was switched to
another class of topical glaucoma medication 1 week
preoperatively.
All eyes underwent standard phacoemulsification with
and postoperative medications (ρ = 0.55, 0.50; P = 0.02, 0.03,
foldable hydrophobic acrylic intraocular lens by a single sur-
respectively).
geon, and all surgeries were uneventful. Postoperatively, oral
All postoperative angle SS-OCT parameters of AOD500,
acetazolamide 250 mg was given HS and topical glaucoma
AOD750, TISA500, TISA750 and SS angle of both the nasal
medications continued/tapered accordingly. The patients were
and temporal quadrants differed significantly from their pre-
followed up at day-1, week-1, month-1, and 6 months.
operative values (Table 3). The median preoperative lens vault
One month postoperatively, angle SS-OCT was repeated
was 0.67 (0.49 to 1.18) mm while the postoperative IOL vault
and above-mentioned parameters were reviewed. The
was −0.63 (−0.87 to 1.00) mm, P < 0.001. The median ITC
numerical differences from their preoperative values were
decreased from 52% (16-100) to 19% (0-97), P < 0.001.
deduced. IOP values at postop day-1, week-1, month-1, and
The correlation between various preoperative meas-
6 months were noted and percentage change in IOP at 1 and
ured and derived variables and percentage change in IOP at
6 months were calculated. The preop and postop number of
postoperative 1-month were analyzed. The derived bio-
glaucoma medications were also noted down.
metric variable LT/AL showed a moderate positive corre-
Statistical analysis was done using Stata 12.0 and SPSS
lation (ρ = 0.50, P = 0.04). SS-OCT measured nasal and
20.0 software. Categorical values were summarized as
temporal AOD and TISA showed significant moderate to
frequency (%) and quantitative values were summarized as
strong negative correlation, with the strongest variable being
mean ± SD, or median (range) if non-normally distributed.
Nasal TISA500 (ρ = −0.83, P < 0.001) (Table 4). The pre-
The preoperative and postoperative parameters were com-
operative circumferential ITC also showed a moderate
pared by Wilcoxan signed-rank tests and trend over time
positive correlation to the percentage IOP change at
was assessed by repeated measure ANOVA tests with Bon-
1 month (rho 0.53, P = 0.03). Of note is that there was no
ferroni correction. Correlation between different parameters
significant difference between the postoperative IOP meas-
was studied by Spearman rank correlation. A P-value of <0.05
ured at 1-month and 6-months follow-up (P = 1).
was considered statistically significant.
The preoperative ITC strikingly showed moderate to
strong correlation with all other angle parameters, both
nasal and temporal (all P < 0.05) (Table 5). The preoperative
RESULTS
The mean age of the studied patients was 57 ± 10 years TABLE 2. Comparison of Intraocular Pressures Precataract
and 61% of them were females. The mean preoperative IOP and Postcataract Surgery
was 31 ± 6 mm Hg. Of note were the mean lens thickness Sl Mean ± SD Overall P btw Diff Time
of 4.44 ± 0.41 mm and lens position 4.58 ± 0.80 mm. The
No Variable (mm Hg) P Points
various preoperative variables have been summarized in
Table 1. 1 Preoperative 31 ± 6 < 0.001* —
The mean postoperative IOP had decreased sig- 2 Postoperative 15 ± 4 1 vs. 2: < 0.001*
nificantly to 15 ± 4 mm Hg on first postoperative day, and day 1
3 Postoperative 14 ± 3 1 vs. 3: < 0.001*
further decreased to 14 ± 3 mm Hg on postoperative 1 week, 1 mo
which sustained until 6 months of follow-up, differing sig- 4 Postoperative 14 ± 2 1 vs. 4: < 0.001*
nificantly from the preoperative value at all time points, 3 mo
P < 0.001 (Table 2). The percentage change in IOP at 5 Postoperative 14 ± 1 1 vs. 5: < 0.001*
1-month and 6-month postoperative period was 53 ± 10% 6 mo
and 58 ± 14%. The number of topical glaucoma medications
Repeated measure ANOVA test applied with Bonferroni correction.
also decreased to 2(1-3), as compared with preoperative Bold values indicate statistically significant.
4(3-5), P < 0.001. The preoperative IOP had moderate *P < 0.05 considered significant.
positive correlation with both the number of preoperative

106 | www.glaucomajournal.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Copyright r 2018 Wolters Kluwer Health, Inc. All rights reserved.
J Glaucoma  Volume 28, Number 2, February 2019 Changes in IOP and Angle After Phaco in PACHT

TABLE 3. Precataract and Postcataract Surgery Comparison of Variables

Sl No Variable Precataract Surgery Postcataract Surgery P
1 No. medications 4 (3-5) 2 (1-3) < 0.001*
2 Best corrected visual acuity 0.3 (0.16-1) 0 (0-0.5) < 0.001*
3 Nasal AOD500 (mm) 0.23 (0.06-0.75) 0.39 (0.12-0.84) < 0.001*
4 Nasal AOD750 (mm) 0.30 (0.09-0.96) 0.60 (0.32-1.16) 0.001*
5 Nasal TISA500 (mm2) 0.07 (0.03-0.21) 0.13 (0.01-0.32) 0.007*
6 Nasal TISA750 (mm2) 0.14 (0.05-0.42) 0.26 (0.06-0.58) 0.001*
7 Nasal SS angle (deg.) 21.80 (7.6-55.3) 40 (23.7-59.60) 0.001*
8 Temporal AOD500 (mm) 0.22 (0.08-0.36) 0.39 (0.14-0.58) 0.005*
9 Temporal AOD750 (mm) 0.32 (0.14-0.57) 0.51 (0.31-0.98) 0.005*
10 Temporal TISA500 (mm2) 0.07 (0.004-0.15) 0.13 (0.02-0.20) 0.035*
11 Temporal TISA750 (mm2) 0.14 (0.04-0.25) 0.23 (0.07-0.37) 0.011*
12 Temporal SS angle (deg.) 24.70 (9.20-35.90) 34.40 (22.40-50.40) 0.015*
13 Lens vault (mm) 0.67 (0.49-1.18) −0.63 (−0.87 to 1.00) < 0.001*
14 ITC (%) 52 (16-100) 19 (0-97) < 0.001*
Wilcoxon signed-rank test applied.
Bold values indicate statistically significant.
*P < 0.05 considered significant.

ACD showed moderate negative correlation with both pre- causing angle closure has been quantified by the lens vault
operative and postoperative ITC (ρ = −0.52; −0.58; P = 0.02, (LV). Shabana et al20 divided PACG into 4 groups based on
0.01, respectively). In addition, the preoperative ITC corre- their mechanism of angle closure, and those because of
lated well with the postoperative ITC (ρ = 0.70, P = 0.001). exaggerated LV had a value of 1.05 ± 0.03. The mean LV in
our study was 0.75 ± 0.22 and when lens extraction was
DISCUSSION done, there was significant reduction in IOP and angle
The “primary angle closure” category of International opening, implying that PACD is a multifactorial disease.12
Society of Geographical and Epidemiological Ophthalmology Numerous parameters have been described in angle
(ISGEO) classification encompasses cases which have an OCT to determine their status and predict the IOP reduction
occludable angle and features suggestive of past angle closure postsurgery.21,22 These were primarily single section
attacks such as peripheral anterior synechiae (PAS), iris whirling, parameters, and do not necessarily reflect the 360 degrees
blotchy angle pigmentation, glaukomflecken and raised IOP.18 circumferential angle status. Moreover, even within the
However, this classification suits better for prevalence surveys, single section, the nasal and temporal parameters are not
and hence, practical circumstances such as the PACHT, more usually identical (Fig. 1), underscoring the variations in
often met in day-to-day practice, needs emphasis. angle within a single eye. Kong et al23 showed that appo-
PACD is commoner in India than the west, primarily sitional angle closure was maximal in the superior quadrant,
attributed to the smaller AL leading to an occludable angle. followed by inferior, nasal and temporal angles in that order
For the same reason, it is commoner in females also, being in primary angle closure suspects. Hence, a single section
reaffirmed by our observation.19 The contribution of lens in study of multiple angle parameters may still be misleading,
and a solitary parameter that would be able to connote the
circumferential angle status is highly desirable. By our
observations, the preoperative ITC had moderate to strong
TABLE 4. Correlation Between Preoperative Angle Parameters correlation with all preoperative studied angle parameters
and % Change in IOP at Postop 1 Month (Table 5) and hence, we propose that ITC may be used as
% Change in IOP the single best parameter to indicate the preoperative angle
status. Also correlating with the % change in IOP post-
Preoperative Variables Spearman Correlation Value P surgery, it may be helpful in predicting the IOP drop
Nasal AOD500 −0.46 0.05 expected after cataract surgery in PACHT patients.
Nasal AOD750 −0.52 0.03* The use of SS-OCT to assess ITC has the benefit of
Nasal TISA500 −0.83 < 0.001* being objective, avoiding interobserver variations, and gives
Nasal TISA750 −0.72 0.001* the overall circumferential status (Fig. 2) as compared with
Nasal SS angle −0.40 0.12 the other parameters that reflect the change in a single fixed
Temporal AOD500 −0.58 0.01* section. However, manually marking the scleral spur and
Temporal AOD750 −0.30 0.23 end-point in numerous sections is time-consuming and if
Temporal TISA500 −0.67 0.003* done by the same observer, would be more reliable.
Temporal TISA750 −0.63 0.006*
Liu et al12 had presented an ASOCT based case series
Temporal SS angle −0.34 0.19
Lens vault 0.02 0.92 with prototype examples for each mechanism of primary
Iridotrabecular contact 0.53 0.02* angle closure. They showed that the amount of ITC
remaining after cataract surgery may be because of
Spearman rank correlation applied. peripheral anterior synechiae or a plateau iris phenomenon.
IOP indicates intraocular pressure.
Bold values indicate statistically significant.
Our study included eyes with both occludable angles and
*P < 0.05 considered significant. synechial angle closure, and the SS-OCT derived ITC does
not differentiate between the two. Postphacoemulsification,

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. www.glaucomajournal.com | 107
Copyright r 2018 Wolters Kluwer Health, Inc. All rights reserved.
Selvan et al J Glaucoma  Volume 28, Number 2, February 2019

TABLE 5. Correlation Between Preop Iridotrabecular Contact (ITC) and Other Preoperative Angle Parameters
Nasal Temporal

AOD500 AOD750 TISA500 TISA750 SS Angle AOD500 AOD750 TISA500 TISA750 SS Angle
Preop ITC ρ (P) −0.50 −0.67 −0.69 −0.71 −0.61 −0.78 −0.62 −0.66 −0.78 −0.67
(0.032)* (0.002)* (0.001)* ( < 0.001)* (0.009)* ( < 0.001)* (0.006)* (0.002)* ( < 0.001)* (0.003)*
Spearman rank correlation test applied.
Bold values indicate statistically significant.
*P < 0.05 considered significant.

though the ITC decreased significantly with respect to their
preoperative status, yet many eyes showed some amount of
residual ITC, directly proportional to their preoperative
ITC (Fig. 3). It may most probably be because of persistent
PAS or anteriorly placed ciliary body, in concordance with
Liu and colleagues’ findings.
The preoperative and postoperative ITC showed significant
negative correlation with preoperative ACD, implying that a
shallower AC may be associated with more extensive irido-
trabecular contact presurgery and postsurgery. Thus, the ACD
can be a preferable biometric parameter in place of ITC in the
absence of SS-OCT facility.

FIGURE 1. Swept source anterior segment optical coherence tomography picture. A, Preoperative narrow-angle. B, Postoperative
widening of angle and their respective parameters. “x” indicates scleral spur and “+” indicates iridotrabecular endpoint. Figure 1 can be
viewed in color online at www.glaucomajournal.com.

108 | www.glaucomajournal.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Copyright r 2018 Wolters Kluwer Health, Inc. All rights reserved.
J Glaucoma  Volume 28, Number 2, February 2019 Changes in IOP and Angle After Phaco in PACHT

FIGURE 2. Swept source anterior segment optical coherence tomography picture showing a decrease in iridotrabecular contact.
A, Preoperative image. B, Postoperative image. “x” indicates scleral spur and “+” indicates iridotrabecular endpoint. Figure 2 can be
viewed in color online at www.glaucomajournal.com.

The main limitation of our study is the small sample
size and short-term follow-up. Also, the novel iris parame-
ters could have added more value to this observation.
Phacoemulsification along with goniosynechialysis have also
been studied in PACD24; however, our group of patients
have shown significant short-term success with the former
alone. Nevertheless, the proportion of patients with persis-
tent ITC because of PAS could have benefitted more from
added goniosynechiolysis. On the other hand, lens extrac-
tion with/without goniosynechiolysis may not alone suffice
in cases of advanced trabecular meshwork damage.
To conclude, PACHT patients benefit significantly from
cataract surgery with marked angle widening, reasonable IOP
reduction and decrease in the number of glaucoma medi-
cations, however, a single best parameter to predict this event is
lacking at present. By our observation, the SS-OCT measured
preoperative ITC index correlated well with all other angle
parameters studied on 2 quadrants, the nasal and temporal,
and may be used as the single best parameter to predict the
postoperative percentage decrease in intraocular pressure. We
also highlight that a study of single-section angle parameters
may not always be indicative of the entire angle status.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. www.glaucomajournal.com | 109
Copyright r 2018 Wolters Kluwer Health, Inc. All rights reserved.
Selvan et al
FIGURE 3. Scatter plot showing the pairs of preoperative (continuous
line) and postoperative (dotted line) circumferential iridotrabecular
contact. Y-axis shows the % of iridotrabecular contact, X-axis shows the
number of patients (n = 18). Figure 3 can be viewed in color online at
www.glaucomajournal.com.
ACKNOWLEDGMENTS
The authors thank Veena Pandey for the statistical
analysis.
REFERENCES
1. Sihota R. Classification of primary angle closure disease. Curr
Opin Ophthalmol. 2011;22:87–95.
2. Kim YY, Jung HR. Clarifying the nomenclature for primary
angle-closure glaucoma. Surv Ophthalmol. 1997;42:125–136.
3. Sihota R, Selvan H, Sharma A, et al. Long-term evaluation of
ocular hypertension with primary angle closure and primary open
angles. Int Ophthalmol. 2018. Doi:10.1007/s10792-018-0872-8.
4. Azuara-Blanco A, Burr J, Ramsay C, et al. Effectiveness of
early lens extraction for the treatment of primary angle-closure
glaucoma (EAGLE): a randomized controlled trial. The Lancet.
2016;388:1389–1397.
5. Trikha S, Perera SA, Husain R, et al. The role of lens extraction
in the current management of primary angle-closure glaucoma.
Curr Opin Ophthalmol. 2015;26:128–134.
6. Nolan W. Lens extraction in primary angle closure. Br J
Ophthalmol. 2006;90:1–2.
7. Traverso CE, Cutolo CA. The effects of phacoemulsification
and intraocular lens implantation on anatomical and functional
parameters in patients with primary angle closure: a prospective
study. (An American Ophthalmological Society Thesis). Trans
Am Ophthalmol Soc. 2017;115:T7.
8. Dada T, Rathi A, Angmo D, et al. Clinical outcomes of clear
lens extraction in eyes with primary angle closure. J Cataract
Refract Surg. 2015;41:1470–1477.
9. Porporato N, Baskaran M, Aung T. Role of anterior segment
optical coherence tomography in angle-closure disease: a review.
Clin Experiment Ophthalmol. 2018;46:147–157.
110 | www.glaucomajournal.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Copyright r 2018 Wolters Kluwer Health, Inc. All rights reserved.
J Glaucoma  Volume 28, Number 2, February 2019
10. Ho S-W, Baskaran M, Zheng C, et al. Swept source optical
coherence tomography measurement of the iris-trabecular
contact (ITC) index: a new parameter for angle closure. Graefes
Arch Clin Exp Ophthalmol Albrecht Von Graefes Arch Klin Exp
Ophthalmol. 2013;251:1205–1211.
11. Kucumen RB, Yenerel NM, Gorgun E, et al. Anterior segment
optical coherence tomography measurement of anterior chamber
depth and angle changes after phacoemulsification and intraocular
lens implantation. J Cataract Refract Surg. 2008;34:1694–1698.
12. Liu L. Deconstructing the mechanisms of angle closure with
anterior segment optical coherence tomography. Clin Experi-
ment Ophthalmol. 2011;39:614–622.
13. Kasai K, Takahashi G, Kumegawa K, et al. Measurement of
early changes in anterior chamber morphology after cataract
extraction measured by anterior segment optical coherence
tomography. Graefes Arch Clin Exp Ophthalmol Albrecht Von
Graefes Arch Klin Exp Ophthalmol. 2015;253:1751–1756.
14. Cho H-K, Ahn D, Kee C. Evaluation of circumferential angle
closure using iridotrabecular contact index after laser iridotomy
by swept-source optical coherence tomography. Acta Ophthal-
mol (Copenh). 2017;95:e190–e196.
15. Melese E, Peterson JR, Feldman RM, et al. Comparing laser
peripheral iridotomy to cataract extraction in narrow angle eyes
using anterior segment optical coherence tomography. PloS
One. 2016;11:e0162283.
16. Vejarano-Restrepo LF. Hypermature cataract: is it impossible
management with Biaxial? In: Arteaga AP. The Science &
Art: Microincision Cataract Surgery (BIMICS & COMICS).
New Delhi, India: JP Medical Ltd; 2012:147–158.
17. Angmo D, Nongpiur ME, Sharma R, et al. Clinical utility of
anterior segment swept-source optical coherence tomography in
glaucoma. Oman J Ophthalmol. 2016;9:3–10.
18. Foster PJ, Buhrmann R, Quigley HA, et al. The definition and
classification of glaucoma in prevalence surveys. Br J Oph-
thalmol. 2002;86:238–242.
19. George R, Paul PG, Baskaran M, et al. Ocular biometry in
occludable angles and angle closure glaucoma: a population
based survey. Br J Ophthalmol. 2003;87:399–402.
20. Shabana N, Aquino MC, See J, et al. Quantitative evaluation of
anterior chamber parameters using anterior segment optical
coherence tomography in primary angle closure mechanisms.
Clin Experiment Ophthalmol. 2012;40:792–801.
21. Guzman CP, Gong T, Nongpiur ME, et al. Anterior segment
optical coherence tomography parameters in subtypes of primary
angle closure. Invest Ophthalmol Vis Sci. 2013;54:5281–5286.
22. Chansangpetch S, Rojanapongpun P, Lin SC. Anterior segment
imaging for angle closure. Am J Ophthalmol. 2018;188:xvi–xxix.
23. Kong X, Foster PJ, Huang Q, et al. Appositional closure
identified by ultrasound biomicroscopy in population-based
primary angle-closure glaucoma suspects: the Liwan eye study.
Invest Ophthalmol Vis Sci. 2011;52:3970–3975.
24. Tun TA, Baskaran M, Perera SA, et al. Swept-source optical
coherence tomography assessment of iris-trabecular contact
after phacoemulsification with or without goniosynechialysis in
eyes with primary angle closure glaucoma. Br J Ophthalmol.
2015;99:927–931.