Combined phacoemulsification and viscogoniosynechialysis in the management of patients with chronic angle closure glaucoma

Abstract

The purpose of this study was to evaluate the effectiveness of phacoemulsification and viscogoniosynechialysis in the management of patients with chronic angle-closure glaucoma (CACG). Fifty-six eyes of 45 recruited patients were classified into two groups: group 1 had medically controlled CACG (IOP <or= 21 mmHg) comprising 35 eyes and group 2 medically uncontrolled CACG (IOP > 21 mmHg with maximum tolerated medications) including 21 eyes. All of the patients had at least one quadrant without peripheral anterior synechia in gonioscopy. After phacoemulsification, a viscoelastic agent was used for viscogoniasynecialysis. Success was defined as IOP <or= 21 mmHg with (relative success) or without (absolute success) medications. There were no statistically significant differences between the two groups regarding age and gender. In group 1, the mean IOP and number of medications declined from 16.7 +/- 2.9 to 14.4 +/- 2.9 (P < 0.0001) and 2.6 +/- 0.8 to 0.82 +/- 0.82 (P < 0.0001), respectively. The absolute success rate at the last follow-up (9 +/- 5.3 months) was 40%. In group 2, the mean IOP and number of medications diminished from 27.95 +/- 8.1 to 15.5 +/- 2.8 (P < 0.0001) and 2.9 +/- 0.62 to 1.2 +/- 1.2 (P < 0.0001), respectively. The absolute success rate was 38.1% at the last follow-up (9.5 +/- 5.3 months). Postoperatively, seven patients developed pupillary fibrin formation that was treated using steroids and ND:YAG laser. In the other two patients, the medically unresponsive cystoid macular edema was treated successfully by intravitreal Bevacizumab. Combined phacoemulsification and viscogoniosynechialysis seem to be an effective surgical procedure in the treatment of patients with CACG and angle restoration whether controlled or uncontrolled by medication.

Effects of Combined Phacoemulsification and Viscogoniosynechialysis versus Trabeculectomy in Patients with Primary Angle-Closure Glaucoma and Coexisting Cataract

“…To open the PAS after cataract surgery, a viscoelastic agent is injected into 360° of the anterior chamber angle. Previous studies have shown that combined phacoemulsification and viscogoniosynechialysis are effective in lowering IOP [17,18,24]. These findings were comparable to our results.…”

“…Third, in those eyes that undergo combined phacoemulsification and viscogoniosynechialysis, if the IOP is not sufficiently controlled, it is more convenient to perform trabeculectomy at a later stage. As the corneal incision used in combined phacoemulsification and viscogoniosynechialysis is transparent, there is no need to consider conjunctival scarring [24]. …”

Microcoaxial Phacoemulsification Combined With Viscogoniosynechialysis for Patients With Refractory Acute Angle-closure Glaucoma

“…12 Microcoaxial phacoemulsification has advantages over standard coaxial phacoemulsification, and the learning curve is less steep when converting from a standard coaxial technique. 13,15 The microincision technique protects the Data were represented as median (range, minimum to maximum), and compared using the Wilcoxon signed-rank test.…”

“…ACD indicates anterior chamber depth; BCVA, best corrected visual acuity; CECC, corneal endothelial cell count; IOP, intraocular pressure; SIA, surgically induced astigmatism. biomechanics and prolate shape of the cornea 17 and results in less SIA and improved visual quality, 15,18 along with rapid wound healing 16,17 and visual rehabilitation, 18 less inflammation, and lower risk of endophthalmitis. 22 It also induces less astigmatism and reduces all intraoperative phaco parameters except total surgical time.…”

“…In another group of patients with chronic ACG, combined phacoemulsification and viscogoniosynechialysis seemed to be effective for chronic ACG and angle restoration whether controlled or uncontrolled by medication. 15 Viscogoniosynechialysis combined with cataract extraction has had a significantly greater effect than cataract extraction alone on lowering IOP in patients with narrowangle glaucoma. 16 Use of phacoemulsification has become widespread, thanks to the development of microincision cataract surgery (MICS).…”