Phacoemulsification Pearls in Angle-Closure Glaucoma

邱欣玲 Shin-Lin ChiuTaiwan Speaker Phacoemulsification Pearls in Angle-Closure GlaucomaPurpose: Phacoemulsification in primary angle-closure glaucoma (PACG) is technically demanding because of shallow anterior chamber, poor pupil dilation, corneal edema, and zonular weakness. This presentation summarizes essential surgical pearls to optimize safety and efficacy in these challenging cases. Methods: Comprehensive surgical steps were reviewed, including preoperative intraocular pressure (IOP) control, intraoperative modifications, and postoperative care. Preoperatively, IOP should be reduced using topical β-blockers, α-agonists, CAIs, PGAs, and systemic dehydrating agents. During surgery, cohesive OVDs are used to deepen the anterior chamber and flatten the iris. A staged continuous curvilinear capsulorhexis (CCC) technique—with OVD refilling from the opposite side—prevents runaway rhexis. Low-fluidics phaco settings, gentle hydrodissection, and capsule tension rings are applied to maintain stability. Intraoperative goniosynechialysis using a spatula or bent needle can restore angle function after IOL implantation. Results: These refinements enhance visualization, prevent iris prolapse, reduce corneal stress, and maintain zonular integrity. Postoperatively, careful monitoring for IOP spikes, inflammation, or malignant glaucoma ensures smoother recovery and better IOP control. Conclusions: Successful phacoemulsification in PACG requires anticipation, chamber stability, and gentle fluidic control. With meticulous planning and adaptation to anatomic constraints, the procedure can achieve both visual improvement and long-term pressure reduction, offering a safe and effective surgical approach for angle-closure glaucoma patients.