Efficacy of phacoemulsification with goniosynechialysis on acute angle-closure glaucoma and cataract complicated with extensive synechial angle closure

• Main Authors: Yan-Chen Wang, Bao-Jun Wang, Hua Yang, Xin-Min Li, Zhi-Qiang Dai
• Format: Article
• Language: English
• Published: Press of International Journal of Ophthalmology (IJO PRESS) 2020-09-01
• Series: Guoji Yanke Zazhi
• Subjects: acute angle-closure glaucoma; cataract; phacoemulsification; goniosynechialysis; optical coherence tomography
• Online Access: http://ies.ijo.cn/cn_publish/2020/9/202009029.pdf

AIM: To assess the clinical efficacy of phacoemulsification, intraocular lens implantation with goniosynechialysis(PEI+GSL)for acute angle closure glaucoma(AACG)and cataract with extensive angle closure synechiae.<p>METHODS: A retrospective study, we studied 35 eyes of 32 patients with AACG and cataract in our hospital. The extent of anterior chamber angle-closure synechiae was defined as an eye with >180°. All patients underwent PEI+GSL and completed an ophthalmologic examination including vision, intraocular pressure(IOP), anterior chamber depth(ACD), angle-opening distance(AOD₅₀₀), trabecular-iris space area(TISA₅₀₀)were observed at 1d, 1wk, 1mo and 3mo after cataract surgery. The angle closure range and retinal nerve fiber layer(RNFL)thickness changes at postoperative 1mo and 3mo were observed, and recorded complications.<p>RESULTS: Postoperative 3mo BCVA(0.334±0.154)and IOP(14.63±3.59mmHg)were improved compared with preoperative(0.914±0.290, 42.54±8.06mmHg)(<i>P</i><0.05). ACD(3.203±0.214mm), OCT angle parameters AOD₅₀₀ and TISA₅₀₀(0.308±0.014, 0.315±0.015mm, 0.134±0.013, 0.139±0.018mm²)were significantly increased compared with preoperation. The extent of angle closure with gonioscopy(72.32±28.33°)decreased compared preoperation(215.29°±30.66°), and RNFL thickness thinner than preoperation(<i>P</i><0.001). Changes in AOD₅₀₀ and TISA₅₀₀ for both nasal and temporal were negatively correlated with IOP, but not with changes in ACD, and no significant complications occurred in the 3mo after surgery.<p>CONCLUSION: The treatment of PEI+GSL can improve vision, deeper ACD and effectively open ACA in the early stage, thus controlling IOP.