The extent of peripheral anterior synechiae and efficacy of combined phacoemulsification and goniosynechialysis in primary angle-closure glaucoma and cataracts: A multicenter prospective study.
Xiong Kun, Wang Yachen, Yu Bo, Zhang Shaodan, Li Guoxing, Huang Qiangjie, Le Rongrong, Xie Yanqian, Mao Huiyan, Zuo JingJing
AI Summary
This study found that combined cataract surgery and goniosynechialysis effectively lowered eye pressure in angle-closure glaucoma, regardless of initial synechiae extent, suggesting broad applicability.
Abstract
Purpose
To investigate the association between the preoperative extent of peripheral anterior synechiae (PAS) and the efficacy of combined phacoemulsification (PEI) and goniosynechialysis (GSL) in primary angle-closure glaucoma (PACG) with cataracts.
Design
Multicenter prospective study METHODS: Patients with PACG and cataracts undergoing PEI-GSL were recruited from five hospitals between November 1, 2022, and March 12, 2024. According to the extent of PAS, the patients were divided into three groups: PAS < 180°, 180°≤ PAS ≤ 270°, and 270°< PAS ≤ 360°. Intraocular pressure (IOP), the number of antiglaucoma medications, cumulative success rates, complications, and reoperations were analyzed. The relationship between chamber angle and IOP was also examined using anterior segment optical coherence tomography (AS-OCT).
Results
Of 232 patients who were enrolled for the surgical outcome analysis. The IOP and the number of antiglaucoma medications were significantly reduced in the three groups after surgery. At 12 months postoperatively, the IOP values were 13.8 ± 3.2 mmHg, 14.3 ± 3.0 mmHg, and 13.6 ± 2.8 mmHg (P > 0.05), and the number of antiglaucoma medications was 0.15 ± 0.66, 0.17 ± 0.50, and 0.04 ± 0.20 (P > 0.05) for the PAS < 180°, 180° ≤ PAS ≤ 270°, and 270°< PAS ≤ 360° groups, respectively. The complete success rates were 83.0 %, 77.1 %, and 84.8 % (P = 0.345), and the qualified success rates were 85.9 %, 87.6 %, and 91.0 % (P = 0.690), respectively. There were no significant differences in complications and reoperation among the three groups (P > 0.05). Furthermore, the change in IOP and the percentage change in IOP increased with the extent of PAS. The AS-OCT parameters were not associated with postoperative IOP (P > 0.05), but some were associated with the change in IOP and the percentage change in IOP.
Conclusions
The success rate and complications of PEI-GSL in treating PACG and cataracts were independent of the baseline extent of PAS. The larger extent of baseline PAS achieved greater IOP reduction postoperatively, and the AS-OCT parameters were related to the change in IOP.
MeSH Terms
Shields Classification
Key Concepts6
The success rate of combined phacoemulsification (PEI) and goniosynechialysis (GSL) in treating primary angle-closure glaucoma (PACG) and cataracts was independent of the baseline extent of peripheral anterior synechiae (PAS) (P = 0.345 for complete success rates, P = 0.690 for qualified success rates).
Complications and reoperations following combined phacoemulsification (PEI) and goniosynechialysis (GSL) in patients with primary angle-closure glaucoma (PACG) and cataracts did not significantly differ among groups with varying baseline extents of peripheral anterior synechiae (PAS < 180°, 180° ≤ PAS ≤ 270°, and 270° < PAS ≤ 360°) (P > 0.05).
The larger the extent of baseline peripheral anterior synechiae (PAS) in patients with primary angle-closure glaucoma (PACG) and cataracts undergoing combined phacoemulsification (PEI) and goniosynechialysis (GSL), the greater the intraocular pressure (IOP) reduction postoperatively.
At 12 months postoperatively, the intraocular pressure (IOP) values after combined phacoemulsification (PEI) and goniosynechialysis (GSL) in patients with primary angle-closure glaucoma (PACG) and cataracts were 13.8 ± 3.2 mmHg for PAS < 180°, 14.3 ± 3.0 mmHg for 180° ≤ PAS ≤ 270°, and 13.6 ± 2.8 mmHg for 270° < PAS ≤ 360° (P > 0.05 for differences between groups).
At 12 months postoperatively, the number of antiglaucoma medications after combined phacoemulsification (PEI) and goniosynechialysis (GSL) in patients with primary angle-closure glaucoma (PACG) and cataracts was 0.15 ± 0.66 for PAS < 180°, 0.17 ± 0.50 for 180° ≤ PAS ≤ 270°, and 0.04 ± 0.20 for 270° < PAS ≤ 360° (P > 0.05 for differences between groups).
Anterior segment optical coherence tomography (AS-OCT) parameters were not associated with postoperative intraocular pressure (IOP) (P > 0.05) but were associated with the change in IOP and the percentage change in IOP in patients with primary angle-closure glaucoma (PACG) and cataracts undergoing combined phacoemulsification (PEI) and goniosynechialysis (GSL).
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