Safety and efficacy of incisional goniotomy as an adjunct with phacoemulsification in primary angle-closure glaucoma

Abstract

Purpose: To evaluate the intraocular pressure (IOP)—lowering efficacy and safety of incisional goniotomy as an adjunct to phacoemulsification in primary angle-closure glaucoma (PACG) patients. Methods: Consecutive patients with PACG (high or borderline IOP) deemed fit for phacoemulsification were enrolled. After phacoemulsification, incisional goniotomy was performed with or without goniosynechialysis. Patient demographic profile, clinical data, and adverse events, if any, were analyzed during at least a 6-month follow-up period. Success was defined as IOP of 18 mm Hg or lesser with or without medications. Setting: Tertiary care Ophthalmic hospital. Design: Prospective interventional case series. Results: Of 46 eyes (38 patients) included, 69.6% eyes were classified as having advanced glaucoma. The mean treated IOP decreased by 7.3 ± 1.0 (SE) mm Hg (95% CI, 5.2-9.3) from 21.4 ± 6.6 to 14.2 ± 3.7 mm Hg at a mean duration of 11.7 ± 5.5 months (6-22 months) postoperatively (P < .001, paired t test). There was 66.6% reduction in median number of hypotensive medications (P < .001, Wilcoxon signed-rank test). Observed complications included hyphema (13 eyes [28%]), IOP spike (3 eyes [6.5%]), and cyclodialysis (1 eye [2.17%]). High treated IOP and number of medications were significantly associated with failure in univariate analysis (P < .05, Fisher exact test). The cumulative survival probability for qualified success at 22 months was 87.8% ± 0.07 (95% CI, 0.65-0.96). Conclusions: Incisional goniotomy as an adjunct with phacoemulsification resulted in a significant and sustained reduction in IOP along with decrease in number of glaucoma medications in chronic PACG eyes, irrespective of the disease stage.

Efficacy and safety of trabeculectomy versus peripheral iridectomy plus goniotomy in advanced primary angle-closure glaucoma: study protocol for a multicentre, non-inferiority, randomised controlled trial (the TVG study)

“…GT, the most popular type of MIGS, has been successfully adopted for PACG using Kahook Dual Blade, [19][20][21] Tanito Microhook, 22 23 or other microhooks or gonioscopy-assisted transluminal trabeculotomy. [24][25][26] However, the evidence was mainly retrospective. 27 An ongoing randomised controlled trial (RCT) is comparing phacotrabeculectomy and phacogoniotomy (PEI+GSL+GT) ( ClinicalTrials.…”

“…Additive IOP-lowering is thus obtained for advanced PACG. GT, the most popular type of MIGS, has been successfully adopted for PACG using Kahook Dual Blade,19–21 Tanito Microhook,22 23 or other microhooks or gonioscopy-assisted transluminal trabeculotomy 24–26. However, the evidence was mainly retrospective 27.…”

Efficacy and safety of phacotrabeculectomy versus phacogoniotomy in advanced primary angle-closure glaucoma: study protocol for a multicentre non-inferiority randomised controlled trial (PVP Study)

“…19 Currently, the effects of various GTs with PEI have been verified in PACG, for instance, GT assisted by Kahook dual blade 20–22 or Tanito microhook (TMH) 23 24 and other microhooks. 25 26 However, the evidence was mainly retrospective. 27 The above proof indicates that goniotomy could be an adjunct to PEI in the treatment of advanced PACG.…”

“… 27 The above proof indicates that goniotomy could be an adjunct to PEI in the treatment of advanced PACG. 25 However, high-quality RCTs to validate the efficacy and safety of MIGS compared with phacotrabeculectomy are still lacking.…”

Minimally Invasive Glaucoma Surgery in Primary Angle-Closure Glaucoma

“…MIGS is increasingly used in the treatment of PACG 17,18. Cataract surgery in combination of MIGS with or without GSL has been reported to be effective and safe in PACG 18–26. For example, cataract surgery with GSL and goniotomy (GT) was more effective than cataract surgery with GSL 27.…”