Early Lens Extraction for Primary Angle Closure Glaucoma – Implications of the EAGLE Trial

Pearls Manager: Hari Jayaram

Patients newly diagnosed with Primary Angle Closure Glaucoma without advanced damage or Primary Angle Closure with IOP ≥ 30mmHg were randomised to either laser peripheral iridotomy (LPI) or clear-lens extraction surgery (CLE). Outcome measures included Quality of Life (EQ-5D), IOP and cost effectiveness at three years.

The EAGLE trial data supported clear-lens extraction as a first-line intervention, with a small but significant advantage for the above outcome measures. There was no difference in visual field outcomes between the two groups at three years. However fewer patients who underwent CLE required treatment to control IOP, including medications and glaucoma surgery, compared to those who underwent LPI.

It is important to note the inclusion criteria for this study, as the findings are not generalisable to all cases of Primary Angle Closure or Primary Angle Closure Glaucoma. Lens extraction surgery in angle closure can be challenging and thus the surgeons in this trial were very experienced. This study did not evaluate the potential of corneal endothelial cell loss which can be associated with CLE surgery.

EGS Guidelines, 5th Edition, Page 47

References:

1. Azuara-Blanco A, Burr J et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet. 2016 Oct 1;388(10052):1389-1397.
2. Javanbakht M, Azuara-Blanco A et al. Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: an economic evaluation based on data from the EAGLE trial. BMJ Open. 2017 Jan 13;7(1):e013254
3. Day AC, Cooper D et al. Clear lens extraction for the management of primary angle closure glaucoma: surgical technique and refractive outcomes in the EAGLE cohort. Br J Ophthalmol. 2018 Dec;102(12):1658-1662.