Efficacy and Safety of Phaco-Goniosynechialysis in Advanced Primary Angle Closure Glaucoma With Severe Visual Field Loss

Abstract

Précis: Phaco-GSL demonstrates promise in safely and efficiently managing advanced PACG cases with tunnel vision or limited temporal visual field. However, caution is advised for patients with only one functioning eye or high visual expectations. Purpose: To assess the efficacy and safety of phacoemulsification with goniosynechialysis (phaco-GSL) in patients with end-stage primary angle-closure glaucoma (PACG) exhibiting tubular vision or temporal field island. Methods: This retrospective study evaluated 68 patients (74 eyes) diagnosed with advanced PACG and exhibiting either tubular vision or temporal field island. All patients underwent phaco-GSL and were monitored for at least one month postoperatively. The study analyzed changes in visual acuity (VA), intraocular pressure (IOP), medication use for anti-glaucoma, and postoperative complications. Results: The mean follow-up time was 9.11±10.49 months. The mean preoperative visual field deviation and VA were −28.01±3.30 dB and 0.36±0.37 logMAR unit, respectively. Postoperatively, the VA for over half (54.1%) of the eyes increased, 29.7% remained unchanged, and 16.2% worsened. The final IOP decreased significantly from 24.65±8.61 to 14.81±3.54 mmHg. Glaucoma medication use also reduced from 1.46±1.43 to 0.88±1.18. The success rate was 48.6% for complete and 89.2% for qualified. IOP spikes (27.0%) and wipe-out (8.1%) were the most common postoperative complications. Vision recovered gradually in five of six wipe-out patients. One eye (1.4%) developed permanent vision loss with VA decreasing to hand motion. Conclusion: Phaco-GSL appears safe and effective in treating advanced PACG cases with tubular vision or temporal field island. However, caution is warranted when considering this treatment option for patients at high wipe-out risk or those with high expectations for visual outcomes.