Phacoemulsification in Angle Closure Glaucoma

Phacoemulsification in angle closure can be challenging. Many factors, including large lens, small pupil and a narrow working space in the anterior chamber, contribute towards an increased level of difficulty. Angle closure eyes are also often associated with increased risk of complications such as malignant glaucoma and suprachoroidal hemorrhage. For the inexperienced or the unsuspecting, phacoemulsification in these eyes can often result in unnecessary and devastating complications, including posterior capsule rupture, dropped nucleus, or suprachoroidal hemorrhage. This chapter therefore aims to identify the surgical challenges presented in eyes with angle closure, and to suggest interventions and surgical techniques that may be useful in ensuring a smooth and uncomplicated surgical course during phacoemulsification. Before we come to this, it is first necessary to look at the aims of and indications for cataract extraction in angle closure.