Combined Phacoemulsification, Goniosynechialysis and Ab Interno Trabeculectomy in Primary Angle-closure Glaucoma: Long-term Results

Abstract

Objective: This research was designed to evaluate the efficacy and safety of ab-interno trabeculectomy (Trabectome and Kahook Dual Blade) combined with phacoemulsification, intraocular lens implantation, and goniosynechialysis in eyes with primary angle-closure glaucoma. Methods: A total of 47 patients were included in the study and all the patients received the combined surgery. Intraocular pressure, anti-glaucoma medications, best-corrected visual acuity, and the number of peripheral anterior synechiae quadrants were recorded at baseline and at various time points after surgery. Results: Intraocular pressure decreased significantly from 20.93 ± 6.53 mmHg preoperatively to 15.09 ± 3.63 mmHg ( P < 0.001) at 36 months. The number of glaucoma medications was significantly reduced from 2.45 ± 1.18 preoperatively to 1.25 ± 1.55 ( P = 0.001) at 36 months. The success rate of the combined surgery was 90.0% at 36 months. The decrease of intraocular pressure exhibited a positive correlation with the baseline intraocular pressure ( P < 0.001), while the reduction in the number of glaucoma medications was positively correlated with the baseline number of glaucoma medications ( P < 0.001). Best-corrected visual acuity improved from 0.39 ± 0.29 to 0.48 ± 0.34 at 1 month ( P = 0.005). There were no vision‑threatening complications intraoperatively or postoperatively. Conclusion: The combined surgery has been proven to be effective and safe for patients with primary angle-closure glaucoma in the long term, suggesting that combined surgery may be beneficial for patients with primary angle-closure glaucoma, especially those with long-term and extensive peripheral anterior synechiae.

Phacoemulsification with IOL implantation combined with goniosynechialysis and goniotomy in primary angle-closure glaucoma following failed trabeculectomy: short-term effectiveness and safety outcomes

“…This is a common and anticipated sequela of goniotomy, resulting from blood reflux through the incised Schlemm’s canal. Importantly, all cases of hyphema were self-limiting, resolving spontaneously within a few days without compromising visual outcomes ( 24 ). For the elderly cohort in our study, this represents a favorable trade-off: prioritizing a superior safety profile and rapid visual rehabilitation over the pursuit of extremely low IOP ( 25 , 26 ).…”

Phacoemulsification with IOL implantation combined with goniosynechialysis and goniotomy in primary angle-closure glaucoma following failed trabeculectomy: short-term effectiveness and safety outcomes

“…This is a common and anticipated sequela of goniotomy, resulting from blood reflux through the incised Schlemm’s canal. Importantly, all cases of hyphema were self-limiting, resolving spontaneously within a few days without compromising visual outcomes ( 24 ). For the elderly cohort in our study, this represents a favorable trade-off: prioritizing a superior safety profile and rapid visual rehabilitation over the pursuit of extremely low IOP ( 25 , 26 ).…”

Phacoemulsification with IOL implantation combined with goniosynechialysis and goniotomy in primary angle-closure glaucoma following failed trabeculectomy: short-term effectiveness and safety outcomes

“…This is a common and anticipated sequela of goniotomy, resulting from blood reflux through the incised Schlemm’s canal. Importantly, all cases of hyphema were self-limiting, resolving spontaneously within a few days without compromising visual outcomes ( 24 ). For the elderly cohort in our study, this represents a favorable trade-off: prioritizing a superior safety profile and rapid visual rehabilitation over the pursuit of extremely low IOP ( 25 , 26 ).…”

Phacoemulsification with IOL implantation combined with goniosynechialysis and goniotomy in primary angle-closure glaucoma following failed trabeculectomy: short-term effectiveness and safety outcomes

“…This is a common and anticipated sequela of goniotomy, resulting from blood reflux through the incised Schlemm’s canal. Importantly, all cases of hyphema were self-limiting, resolving spontaneously within a few days without compromising visual outcomes ( 24 ). For the elderly cohort in our study, this represents a favorable trade-off: prioritizing a superior safety profile and rapid visual rehabilitation over the pursuit of extremely low IOP ( 25 , 26 ).…”