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

Abstract

Aims: To compare the effectiveness of combined phacoemulsification and viscogoniosynechialysis versus trabeculectomy alone in primary angle-closure glaucoma (PACG) with a coexisting cataract. Methods: Thirty-nine Chinese patients (39 eyes) were retrospectively analyzed: 19 patients underwent combined phacoemulsification and viscogoniosynechialysis (group 1), and 20 underwent trabeculectomy (group 2). In both groups, the intraocular pressure (IOP), the number of antiglaucoma medications, the best corrected visual acuity (BCVA), the central anterior chamber depth (ACD), the synechial/apposition angle closure (SAC), and the success rates were assessed. Results: The median follow-up periods were similar for both groups (10 months). At the last follow-up, the mean IOP was 14.09 ± 6.89 mm Hg and the mean number of antiglaucoma medications was 0.36 ± 0.59 in group 1; in group 2, the mean IOP was 16.48 ± 4.74 mm Hg (p = 0.066) and the mean number of antiglaucoma medications was 1.05 ± 0.99 (p = 0.025). In terms of the mean central ACD and the mean SAC, there were significant differences between the groups (p = 0.0000, respectively). Kaplan-Meier analysis revealed that the cumulative probability of success in group 1 was higher than that in group 2 (p = 0.0051). Conclusion: Compared to trabeculectomy, combined phacoemulsification and viscogoniosynechialysis resulted in a lower requirement for glaucomatous medications, a greater improvement in BCVA, and a higher cumulative probability that treatment would be successful among patients with PACG and coexisting cataracts.

A Meta-Analysis: Safety and Efficacy of Phacoemulsification with Goniosynechialysis versus Trabeculectomy for Acute Angle Closure Glaucoma in China

“…20 literary works from 2011 to 2022 were eventually included in the meta-analysis, as follows: Guoying Liu 2017 [16], Siyi Zhang 2016 [17], Zhaorong Zeng 2013 [18], Zaifang Wang 2019 [19], Kun Wang 2019 [20], Jili Chen 2017 [21], Canhua Huang 2019 [22], Ayinuer 2015 [23], Tang Y 2012 [24], Zhang H 2016 [12], Yanjun Huang 2011 [25], Kai Ma 2015 [26], Tian Yang 2019 [27], Lianrong Su 2013 [28], Ning Ma 2018 [29], Chaohua Huang 2018 [30], Yufei Cai 2021 [31], Qingzhi Wang 2020 [32], Shuifeng Deng 2021 [33], Yongqiang Liang 2013 [34]. Figure 1 depicts the literature screening procedure.…”

Managing Primary Angle Closure Glaucoma – The Role of Lens Extraction in this Era

“…Tang et al retrospectively compared the effectiveness of combined phacoemulsification and viscogoniosynechia-lysis (phaco-GSL) with trabeculectomy alone in PACG with coexisting cataract [ 28 ]. They analyzed 19 patients who underwent phaco-GSL and 20 patients who underwent trabeculectomy.…”

Schlemm's Canal Expands After Trabeculectomy in Patients With Primary Angle–Closure Glaucoma

“…5 Intraocular lens surgery was not performed simultaneously in each patient. Briefly, trabeculectomy was performed under peribulbar anesthesia.…”

“…3 In addition, previous reports have suggested that canaloplasty, a procedure involving circumferential viscodilation and tensioning of Schlemm's canal, achieved a significant decrease in IOP at 12 months and the IOP decrease is sustained in adult patients with open-angle glaucoma. [4][5][6] Since trabeculectomy could significantly decrease the IOP in PACG eyes, this surgical treatment could result in changes in the SC. However, the features of SC morphology in PACG eyes undergoing trabeculectomy are still unknown.…”