No abstract

The effectiveness of intraocular pressure (IOP) lowering phacoemulsification combined with goniosynechialysis (GSL) compared with phacoemulsification without GSL remains unknown. OBJECTIVE To compare the IOP outcome after 1 year in patients with synechial primary angle-closure disease (PACD) and cataract who underwent phacoemulsification with intraocular lens implantation (PEI) alone compared with PEI with GSL (PEI-GSL).

Purpose: To evaluate the clinical outcomes of minimally invasive cataract extraction by phacoemulsification, with primary intraocular lens implantation, in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract. Materials and Methods:Consecutive primary angle-closure glaucoma patients with co-existing visually significant cataract were invited to participate in this prospective study. After obtaining informed consent, cataract extraction by phacoemulsification through a clear corneal incision was performed under topical anesthesia. Foldable intraocular lenses were implanted in the same setting. These patients were then followed up for a minimum of 1 year. Outcome measures included intraocular pressure (IOP), requirement for glaucoma drugs, and visual acuity.Results: Twenty-one primary angle-closure glaucoma eyes of 21 patients were recruited. Mean age (6 SD) was 73.7 6 8.1 years (range, 60-87 years). There were 12 female patients and 9 male patients, with 13 right eyes and 8 left eyes. Nine eyes (42.9%) had history of acute primary angle closure. Mean follow-up duration was 20.7 6 3.6 months (range, 13-26 months). Intraocular pressure was decreased from a mean preoperative level of 19.7 6 6.1 mm Hg (range, 11 mm Hg-40 mm Hg) to 15.5 6 3.9 mm Hg (range, 9 mm Hg-26 mm Hg) at final follow-up (P = 0.022) (paired t test). The number of glaucoma eye drops required was decreased from a mean preoperative level of 1.91 6 0.77 (range, 1-3) to 0.52 6 0.87 (range, 0-3) at final follow-up (P , 0.001) (paired t test). In 10 eyes (47.6%), visual acuity improved significantly after surgery. In 9 eyes (42.9%), visual acuity remained the same. In 2 eyes (9.5%), visual acuity deteriorated significantly after surgery. Mean cup-to-disc ratio was 0.6 6 0.2 (range, 0.3-0.9) preoperatively, and 0.7 6 0.2 (range, 0.3-0.9) postoperatively (P = 0.047) (paired t test). Conclusions:In primary angle-closure glaucoma patients with co-existing cataract, cataract extraction alone (by phacoemulsification) can significantly reduce both intraocular pressure and the requirement for glaucoma drugs.