Predictors of long-term intraocular pressure control after clear lens extraction in primary angle closure glaucoma: results from the EAGLE

David Friedman, William Mitchell, Augusto Azuara-Blanco, Jennifer Burr, Craig Ramsay, David Cooper, Claire Cochrane, John Norrie, Dolly Chang

Research output: Contribution to journalAbstractpeer-review


Purpose : The EAGLE trial provides evidence supporting the use of initial early lens extraction (ELE) as a first-line intervention for patients with primary angle closure glaucoma (PACG) or primary angle closure (PAC) with high intraocular pressure (IOP). We assess baseline parameters associated with better long-term IOP control using data from the EAGLE trial.

Methods : The EAGLE trial was a multicenter randomized controlled study comparing ELE with laser peripheral iridotomy (LPI) in patients who did not have cataract and had newly diagnosed PAC with IOP ≥ 30mmHg or PACG. Good responders were defined as IOP <21mmHg at 36-month follow up without using any medications and requiring no additional surgery.

Results : A total of 369 patients (182 in ELE arm and 187 in LPI arm) who completed the 36-month follow up visit were included in this study. Among 419 randomized participants, only one study eye randomized to ELE underwent trabeculectomy (0.5%) while six had trabeculectomy in the LPI arm (2.8%). After ELE, 66% met our pre-defined good response criterion at 36 months with significantly longer drops/surgery-free survival time as compared to only 18% in the LPI arm (p < 0.05). Using a multi-variate Cox proportional hazards model, patients randomized to LPI [Hazard ratio (HR) (95% CI)=2.52 (1.92-3.31)], non-Chinese [HR=1.52 (1.14-2.05)], those who used glaucoma drops before [HR=1.48 (1.12-1.95)] and those who had higher baseline IOP [HR=1.02 (1.00-1.03) per 1mmHg] were less likely to maintain long-term good IOP control over 36 months. Other baseline characteristics such as age, gender, diagnosis (PACG versus PAC), presence of peripheral anterior synechiae, anterior chamber depth, baseline visual field and visual acuity were not associated with long-term IOP control.

Conclusions : Patients with PACG/PAC are more likely to maintain drops-free good IOP control with initial ELE surgery than LPI. Chinese ethnicity, higher baseline IOP and using glaucoma drops prior to randomization are predictors of worse long-term IOP response.
Original languageEnglish
Number of pages2
JournalInvestigative Ophthalmology & Visual Science
Issue number8
Publication statusPublished - Jun 2021


Dive into the research topics of 'Predictors of long-term intraocular pressure control after clear lens extraction in primary angle closure glaucoma: results from the EAGLE'. Together they form a unique fingerprint.

Cite this