Clear lens extraction as the first line treatment of primary angle closure/primary angle closure glaucoma

Angle closure glaucoma (ACG) is one of the major causes of blindness. Angle closure occurs from the obstruction of the trabecular meshwork by the peripheral iris, which results in increased intraocular pressure (IOP) through impaired aqueous flow. Considering pupillary block by crystalline lens is the most frequent mechanism, lens extraction is regarded as an effective therapy. Recently, to validate the effect of lens extraction, the EAGLE study was reported. In this study, subjects were 50 years or older, did not have cataracts, and had newly diagnosed primary angle closure (PAC) with intraocular pressure 30 mmHg or greater or primary angle-closure glaucoma (PACG), and were divided into clear-lens extraction group and standard care group (laser peripheral iridotomy and topical glaucoma medication). This study suggested that clear-lens extraction showed greater efficacy and was more cost-effective than laser peripheral iridotomy. Initial clear lens extraction showed better clinical course and patient-reported outcomes. This study provided evidence to support clear lens extraction as the first line treatment for PAC with high IOP or PACG patients.