Comparative Evaluation of Phacoemulsification Alone versus Phacoemulsification with Goniosynechialysis in Primary Angle-Closure Glaucoma

Angmo, Dewang; Shakrawal, Jyoti; Gupta, Bindiya; Yadav, Suresh; Pandey, RM; Dada, Tanuj

doi:10.1016/j.ogla.2019.05.004

Cited by 18 publications

(19 citation statements)

References 28 publications

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“…Previous studies have demonstrated that the postoperative IOP can be well-controlled by phacoemulsi cation and IOL implantation alone for patients with angle-closure glaucoma, accompanied by PAS of < 180°, whereas patients with excessive chamber angle adhesion GSL should be considered to separate these adhesions [22] . However, we believe that we should also routinely combine phacoemulsi cation with GSL for patients with PAS of < 180° to separate the PAS as much as possible, protect the drainage function of the angle, and avoid the progression of synechia, which may ultimately increase the IOP.…”

Section: Discussionmentioning

confidence: 99%

Early intraocular pressure spike after phacoemulsification with intraocular lens implantation and goniosynechialysis in primary angle-closure glaucoma

Zuo

et al. 2022

Preprint

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Purpose: To evaluate the characteristics and associated risk factors of early postoperative intraocular pressure (IOP) spike in patients undergoing phacoemulsification with intraocular lens implantation and goniosynechialysis in primary angle-closure glaucoma.Design: Retrospective case series.Patients and Methods: Patients with consecutive primary angle-closure glaucoma patients without previous incisional glaucoma surgery who had undergone phacoemulsification with intraocular lens implantation and goniosynechialysis (PEI-GSL) by the same surgeon between January 2017 and November 2019 were reviewed to obtain the demographic information, number of antiglaucoma medications, preoperative IOP, pre-operative peripheral anterior synechiae (P-PAS), axial length (AL), anterior chamber depth (ACD), lens thickness (LT), mean deviation (MD), as well as pattern standard deviation (PSD) of the visual field (VF), Optic Vertica Cup-to-Disc ratio (C/D), intraoperative PAS remain (I-PAS), and postoperative outcomes. A postoperative early IOP spike was defined as an IOP of at least 21 mmHg at 2 h post-operation. The main outcome parameters were the frequency and distribution of postoperative IOP spikes and the risk factors associated with an IOP spike after PEI-GSL.Results: Of 100 eyes (100 patients) included in the study, 32% showed an early IOP spike (IOP spike group), while 68% showed no early IOP spike (no IOP spike group). Eleven patients (34.3%) from the IOP spike group showed an IOP value of ≥30 mmHg, and all underwent 2.82 times of aqueous humor release postoperatively. In the IOP spike group, twelve patients (37.5%) showed an IOP value of ≥21 mmHg at postoperative day (POD) 1, while three (9.4%) showed an IOP value of ≥21 mmHg at POD 7. The overall success rate was 89.74%, and the qualified success rate was 95.12% at the last follow-up (mean = 19.9 months, range 6–46 months). There was no significant difference in the frequency of IOP levels of ≥ 21 mmHg between the IOP spike group and the non-IOP spike group at the last visit (Fisher exact test, P = 1.000). Diagnosis of APACG or CPACG was associated with P-PAS, ACD, and PSD of VF but not with IOP spike (F = 4.003, P = 0.045).Conclusions: A significant percentage of PACG patients undergoing PEI-GSL had IOP spike at 2 h postoperatively. Side-port release of aqueous humor and use of antiglaucoma medications can effectively reduce IOP within one week after surgery. IOP spike was observed more frequently in patients with CPACG than in patients with APACG at 2 h postoperatively. Postoperative IOP spike did not affect the long-term success rate of IOP control.

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Section: Discussionmentioning

confidence: 99%

Early intraocular pressure spike after phacoemulsification with intraocular lens implantation and goniosynechialysis in primary angle-closure glaucoma

Zuo

et al. 2022

Preprint

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“…23 Conversely, Tham et al concluded that phaco-trabeculectomy controls IOP better than phacoemulsification alone, but it may be associated with more complications. 21 Goniosynechialysis is an adjunctive maneuver to phacoemulsification for treatment of PACG that added benefit according to Angmo et al 46 but had no additive effect according to Lee and colleagues. 47 In contrast to our results, Yudhasompop et al concluded that although phacoemulsification improved both IOP and visual acuity, the change in IOP was not significantly correlated with ACD or lens thickness.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Effect of Early Phacoemulsification in Primary Angle Closure Glaucoma Patients with Cataract: A 10-Year Follow-Up Study

Helmy¹

2021

OPTH

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Purpose To assess the 10-year effects of early phacoemulsification with intraocular lens (IOL) implantation in primary angle closure glaucoma (PACG) patients with cataract. Patients and Methods This prospective cohort study included 102 eyes of 102 patients with PACG. All patients had coexisting cataracts compromising vision. Patients underwent phacoemulsification and foldable IOL implantation. The main outcome measures were anterior chamber depth (ACD), angle width, value of intraocular pressure (IOP), and number of medications needed postoperatively and during follow-up. Results Half (53%) of the patients were female, with ages ranging from 55 to 73 with a mean of 59.82±5.19 years. Mean IOP decreased significantly from 22.15±2.08 mmHg at baseline to 14.08±2.13 mmHg postoperatively (p˂ 0.05). The ACD increased from 2.2±0.21 preoperatively to 3.73±0.25 postoperatively (p˂0.001). Nasal angle width increased postoperatively to 40.05±2.09 compared to the preoperative value of 16.02±2.08 (p˂0.001). Temporal angle width increased from 13.05±2.07 to 41.9600±1.94 (p˂0.001). Anti-glaucoma treatment significantly decreased postoperatively (p˂0.001). A significant positive correlation was detected between ACD and angle width, while a negative correlation was detected between IOP and both ACD and angle width (p˂0.001). There was also a significant negative correlation between postoperative angle width and IOP (p˂0.001). Preoperative lens thickness was positively correlated with preoperative IOP and number of medications, while it was negatively correlated with preoperative AC depth and angle width. Preoperative lens thickness positively correlated with postoperative IOP and medications. Complete and qualified success was achieved in 69.65% and 30.4% of cases, respectively, while 2.9% failed to be controlled. Visual acuity significantly improved from 0.17±0.1 to 0.9±0.08 (p˂0.001). All parameters showed high stability throughout the follow-up period. Conclusion Phacoemulsification with IOL implantation is a safe and effective early modality for long-term control of IOP in PACG patients with coexisting cataract. The effects can persist for at least 10 years.

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“…Cataract surgery alone or in combination with GSL have been shown to be associated with significant IOP reduction but they may not be adequate to lower IOP in eyes with advanced PACG 6. Cataract surgery is effective in relieving pupillary block, deepening the anterior chamber, thereby enhancing the aqueous drainage through the TM and reducing the risk of progressive PAS formation 79.…”

Section: Methodsmentioning

confidence: 99%

“…Trabeculectomy or in combination with phacoemulsification with intraocular lens implantation (PEI) has been one of the first-line surgical options for PACG for decades 3. Nonetheless, complications of trabeculectomy including malignant glaucoma, persistent hypotony, and other bleb-related complications can be vision-threatening 6,7. Moreover, postoperative care can be challenging.…”

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confidence: 99%

Minimally Invasive Glaucoma Surgery in Primary Angle-Closure Glaucoma

Song

Zhang

et al. 2022

Asia-Pacific Journal of Ophthalmology

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Primary angle-closure glaucoma (PACG) is responsible for half of the glaucoma-related blindness worldwide. Cataract surgery with or without trabeculectomy has been considered to be the first-line treatment in eyes with medically uncontrolled PACG. While minimally invasive glaucoma surgery has become an important surgical approach for primary open-angle glaucoma, its indications and benefits in PACG are less clear. This review summarizes the efficacy and safety profile of minimally invasive glaucoma surgery in PACG to unfold new insights into the surgical management of PACG.

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Comparative Evaluation of Phacoemulsification Alone versus Phacoemulsification with Goniosynechialysis in Primary Angle-Closure Glaucoma

Cited by 18 publications

References 28 publications

Early intraocular pressure spike after phacoemulsification with intraocular lens implantation and goniosynechialysis in primary angle-closure glaucoma

Early intraocular pressure spike after phacoemulsification with intraocular lens implantation and goniosynechialysis in primary angle-closure glaucoma

Long-Term Effect of Early Phacoemulsification in Primary Angle Closure Glaucoma Patients with Cataract: A 10-Year Follow-Up Study

Minimally Invasive Glaucoma Surgery in Primary Angle-Closure Glaucoma

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