Management and outcomes of acute primary angle closure with phacoemulsification: a clinical audit at hospital Tengku Ampuan Rahimah

Purpose: To evaluate the demographic characteristics, treatment effects, and timing of cataract extraction of patients with acute primary angle closure (APAC) in Hospital Tengku Ampuan Rahimah (HTAR), Klang, Malaysia. Study design: Retrospective descriptive analysis. Methods: This study included 17 patients with APAC in HTAR from 2021 to 2024. Data on demographics, visual acuity (VA), intraocular pressure (IOP), and antiglaucoma medications (including oral acetazolamide) were collected at presentation, preoperatively, and 3 months postoperatively following phacoemulsification with posterior chamber intraocular lens implantation (PCIOL). Results: There were 10 females (58.8%) and 7 males (41.2%), with age ranging from 42 to 84 years. Seven patients (41.2%) were Malay, 7 (41.2%) were Chinese, and 3 patients (17.6%) were Indian. A total of 14 patients (82.4%) underwent phacoemulsification within 6 weeks of presentation. Mean IOP was 50.44 mmHg upon attack, 18.24 mmHg during abortion of attack, and 13.06 mmHg after surgery (p < 0.001). Mean logMAR VA improved from 1.00 to 0.62 (p < 0.001). Oral acetazolamide use declined significantly from 8 patients upon attack to 2 postoperatively (p = 0.002). However, 13 out of 17 patients (76.5%) of patients still required 2 or more topical IOP-lowering medications at final follow-up. No significant relationship was found between preoperative medication burden and early surgical timing. Conclusion: Cataract surgery effectively improves VA and IOP and reduces dependency on systemic acetazolamide. Nevertheless, a high proportion of patients progress to require long-term topical therapy for chronic glaucoma, underscoring the need for ongoing monitoring. Further studies are required to determine the optimal timing for cataract surgery in APAC.