Combined Phacoemulsification with Goniosynechialysis under Ophthalmic Endoscope for Primary Angle-closure Glaucoma after Failed Trabeculectomy

Abstract

Precis: Phaco-OE-GSL is safe and able to lowering IOP for failed trabeculectomy in PACG with cataract. The larger pupil diameter and younger age are identified as the two risk factors for surgical outcome.

Purpose: To investigate the efficacy and safety of combined phacoemulsification with goniosynechialysis under an ophthalmic endoscope (Phaco-OE-GSL) for primary angle-closure glaucoma with cataract after failed trabeculectomy.

Materialsand methods: Twenty-five patients (25 eyes) were enrolled in this retrospective study. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), and number of glaucoma medications at baseline and each postoperative follow-up visit were recorded. Peripheral anterior synechia (PAS) was recorded using gonioscopy. Binary logistic regression was used to analyze the risk factors of surgical failure.

Results: The mean follow-up duration was 17.9±11.4 months. The mean IOP was significantly lower than the preoperative baseline IOP at all time points (P < 0.001). The mean IOP was reduced from 24.4±6.5▒mmHg at baseline to 14.2±3.0▒mmHg at the last follow up. The mean preoperative number of glaucoma medications was 2.2±1.2, which reduced to 0.9±1.1 at the last follow-up. The complete success rates at 1-year and the last follow-up were 70.6% and 68%, respectively. The total success rates were 96% and 92%, respectively. The most common postoperative complications were IOP spikes (48%) and hyphemas (32%). All eyes had degrees of PAS recurrence, with a range of 96.1±52.50 (30 – 2100) after 4 – 6 months. Larger pupil diameter and younger age were significantly associated with the failure of Phaco-OE-GSL.

Conclusions: Phaco-OE-GSL is safe and can lower IOP for failed trabeculectomy in PACG with cataract despite the high recurrence rate of PAS.