Aqueous outflow facility after phacoemulsification with or without goniosynechialysis in primary angle closure: a randomised controlled study

Rodrigues, Ian; Alaghband, Pouya; Beltran‐Agullo, Laura; Galvis, Elizabeth; Jones, Stephanie; Husain, Rahat; Lim, Kin Sheng

doi:10.1136/bjophthalmol-2016-309556

Cited by 41 publications

(35 citation statements)

References 16 publications

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“…Goniosynechialysis is a technique that mechanically strips PAS from the trabecular meshwork to restore the trabecular function 4 13 and improves the trabecular outflow facility. 4 Normalization of IOP post-GSL depends on the function of trabecular meshwork. Prolonged PAS may lead to irreversible damage to the trabecular mesh-work, and it is therefore important to consider the likely duration that the PAS has been present before undertaking GSL.…”

Section: Discussionmentioning

confidence: 99%

“…This may affect the long-term success of cataract surgery in controlling IOP. Combined phaco-emulsification and GSL 3 4 has been shown to successfully control IOP in these types of PACG cases. Although the number of medications required to control IOP after phaco-GSL is shown to be significantly less than phaco alone, 4 5 often it cannot eliminate the need for further IOP lowering medications or glaucoma drainage surgery.…”

Section: Introductionmentioning

confidence: 99%

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Phacoemulsification with Intraocular Implantation of Lens, Endocyclophotocoagulation, and Endoscopic-Goniosynechialysis (PIECES): A Combined Technique for the Management of Extensive Synechial Primary Angle Closure Glaucoma

Alaghband

Rodrigues

Goyal

2018

Journal of Current Glaucoma Practice

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Primary angle closure glaucoma (PACG) is more blinding (1 in 4 cases) than primary open angle glaucoma (1 in 10 cases). Cataract surgery is an effective initial treatment for majority of cases of PACG. However, cataract surgery alone may not be enough to control intraocular pressure (IOP) in cases with extensive synechial angle closure glaucoma. It is reported that glaucoma drainage surgery is needed in 12% of PACG cases after cataract surgery. Some experts combine cataract surgery with either goniosynechialysis (GSL) or endocyclophotocoagulation (ECP) to enhance IOP control. However, neither combination ensures complete success. We report three subjects with extensive synechia! angle closure in whom we facilitated a technique that combines lens extraction with ECP and endoscopic—GSL (PIECES). We demonstrated that this combined technique was a more effective and efficient method of achieving lower IOP in the presence of extensive synechial PACG. We believe that it addresses both the inflow and outflow of the aqueous humor simultaneously. Two out of three patients had good IOP control without medication and one patient needed one drop after a minimum 12 months of follow up. Furthermore, it may reduce the need for medical therapy and future more invasive glaucoma drainage surgery.How to cite this article: Alaghband P, Rodrigues IAS, Goyal S. Phacoemulsification with Intraocular Implantation of Lens, Endocyclophotocoagulation, and Endoscopic-Goniosynechialysis (PIECES): A Combined Technique for the Management of Extensive Synechial Primary Angle Closure Glaucoma. J Curr Glaucoma Pract 2018;12(1):45-49.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Phacoemulsification with Intraocular Implantation of Lens, Endocyclophotocoagulation, and Endoscopic-Goniosynechialysis (PIECES): A Combined Technique for the Management of Extensive Synechial Primary Angle Closure Glaucoma

Alaghband

Rodrigues

Goyal

2018

Journal of Current Glaucoma Practice

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“…Goniosynechialysis combined with cataract removal is commonly utilized to treat acute and chronic PACG. [ 11 – 12 ] This procedure can allow peripheral anterior synechiae to be effectively detached. When combined with cataract removal, goniosynechialysis can permit widening and opening of the anterior chamber angle to increase anterior chamber depth and lower the intraocular angle.…”

Section: Discussionmentioning

confidence: 99%

Goniosynechialysis combined with cataract extraction for iridoschisis

You

Qin²,

Li³

et al. 2017

Medicine

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Rationale:Iridoschisis is a rare eye disease. In this case report, we described the examination and diagnosis of a case of iridoschisis accompanied by secondary glaucoma. We also observed the effects of treating the patient with a combination of goniosynechialysis and cataract removal.Patient concern:A 67-year-old female patient presented with decreased vision in both eyes. An eye examination indicated that visual acuities (VAs) were 20/100 and light perception in the right and left eyes, respectively. Both eyes exhibited shallow anterior chambers and narrow angles. The lower portion of the iris was loosened, and cable-like tissue was visible. The intraocular pressures in the right and left eyes were 22 mmHg and 58 mmHg, respectively. At the time of presentation, no medication was being used.Diagnoses:The patient was diagnosed with iridoschisis [oculus sinister (OU), indicates left eye], secondary glaucoma (OU), senile cataract (OU), and pterygium (oculus uterque, indicates both eyes).Intervention:After relevant examinations were conducted, goniosynechialysis and phacoemulsification with intraocular lens implantation were performed on the right eye under local anesthesia.Outcomes:Two days after surgery, the right eye had VA of 20/40 and a transparent cornea. The anterior chamber was deeper, and intraocular pressure had decreased to 16 mmHg. Three months after surgery, the patient exhibited improved VA in the right eye and a lower IOP of 11 mmHg.Lessons:Relative to other approaches, goniosynechialysis combined with cataract removal is a better treatment option for iridoschisis complicated with closed-angle glaucoma triggered by peripheral anterior synechiae.

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“…Detailed pre-and postoperative gonioscopic examinations identify the presence and extent of PAS and predict long-term IOP changes. Phaco/IOL combined with goniosynechialysis or endocyclophotocoagulation (ECP) may be considered in eyes with extensive PAS to achieve better IOP control [24][25][26].…”

Section: Kaplan-meier Survival Estimatesmentioning

confidence: 99%

Early versus Delayed Phacoemulsification and Intraocular Lens Implantation for Acute Primary Angle-Closure

Lin

Huang

et al. 2020

Journal of Ophthalmology

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Purpose. To compare the effects of early phacoemulsification and intraocular lens implantation (phaco/IOL), delayed phaco/IOL after initial laser peripheral iridotomy (LPI), and conventional LPI alone in patients with acute primary angle-closure (PAC). Methods. Patients with acute PAC were included in the study, and those with secondary glaucoma, prior ocular trauma, or other ocular diseases and those who had undergone ocular surgeries previously were excluded. Patients were categorized into three groups: Group A, which underwent primary phaco/IOL after acute PAC; Group B, which underwent LPI initially after acute PAC, followed by phaco/IOL within 6 months; and Group C, which underwent LPI alone. The IOP control success at 12 months as well as changes in ocular characteristics and the number of antiglaucoma medications used after the treatment among the groups were evaluated. Results. Eighty-one eyes were included in the study: 24 eyes in Group A, 23 eyes in Group B, and 34 eyes in Group C. The linear mixed model analysis demonstrated considerable IOP control in Groups A and B. Visual acuity, anterior chamber depth (ACD), and angle width improved significantly in Groups A and B, but not in Group C. The number of antiglaucoma medications used was significantly higher in Group C than in Groups A and B. Conclusions. Patients who underwent phaco/IOL had better IOP control, improved vision, deeper ACD, and wider angle and required less antiglaucoma medications than those who underwent LPI alone. Performing phaco/IOL weeks to months after the initial LPI did not appear to adversely affect outcomes compared with those of early phaco/IOL.

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Aqueous outflow facility after phacoemulsification with or without goniosynechialysis in primary angle closure: a randomised controlled study

Abstract: NCT00719290, Results.

Cited by 41 publications

References 16 publications

Phacoemulsification with Intraocular Implantation of Lens, Endocyclophotocoagulation, and Endoscopic-Goniosynechialysis (PIECES): A Combined Technique for the Management of Extensive Synechial Primary Angle Closure Glaucoma

Phacoemulsification with Intraocular Implantation of Lens, Endocyclophotocoagulation, and Endoscopic-Goniosynechialysis (PIECES): A Combined Technique for the Management of Extensive Synechial Primary Angle Closure Glaucoma

Goniosynechialysis combined with cataract extraction for iridoschisis

Early versus Delayed Phacoemulsification and Intraocular Lens Implantation for Acute Primary Angle-Closure

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