Efficacy of Phacoemulsification Alone vs Phacoemulsification With Goniosynechialysis in Patients With Primary Angle-Closure Disease

Husain, Rahat; D, Tan; Lai, Jimmy Shiu Ming; Kitnarong, Naris; Nongpiur, Monisha E.; Perera, Shamira; Ho, Ching Lin; Lim, Sheng; Aung, Tin

doi:10.1001/jamaophthalmol.2019.2493

Cited by 52 publications

(88 citation statements)

References 21 publications

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“…Hence, in our study, although the IOP was normal preoperatively, GSL was still performed in eyes with PAS. It is said higher baseline IOP resulted greater IOP reduction [29]. In this study, the preoperative IOP was all under 21 mmHg with a mean IOP of 13.8 ± 3.3 mmHg.…”

Section: Discussionmentioning

confidence: 52%

“…And this may be the reason that the final result did not demonstrate a significant difference between PEI and PEI-GSL. In addition, at 12 months after surgery, the PAS in the PEI-GSL was slight less than in the PEI in the Husain's study [29]. This may indicate that combined with GSL may warrant a longer time for angle open in PACG which in turn will benefit the IOP maintainance.…”

Section: Discussionmentioning

confidence: 78%

“…The various effects of GSL may be due to the differed PAS, study population and short follow up duration. In the most recent one randomized clinical trial, GSL did not show additional IOP lowering effect over PEI alone [29]. However, the subgroups of Singapore and Vietnam displayed opposite results of the two surgical procedures.…”

Section: Discussionmentioning

confidence: 89%

“…However, it had more postoperative complications (8 complications vs 0 complication) like "wipe out", ocular hypotony and poor IOP control [17,27]. Compared with trabeculectomy, GSL was reported to be safe with mild complications including intraoperative hyphema, mild zonulysis and postoperative IOP spikes [28,29]. Medically uncontrolled glaucomatous eyes warrant surgeries to decease IOP since elevated IOP increases the risk of glaucoma progression.…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, 17 eyes underwent combined PEI-GSL and only 2 eyes received PEI alone since in the perioperative examination, PAS was not found in these 2 eyes. PEI alone was reported to sufficiently reduce the IOP in PACG and whether GSL should be combined was controversial in previous studies [29,30]. The mechanism that PEI decreasing the IOP in PACG is that lens extraction can partly relieves the role of anteriorly positioned lens in the PACG by implanting a much thinner IOL.…”

Section: Discussionmentioning

confidence: 99%

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Long term outcomes of cataract surgery in severe and end stage primary angle closure glaucoma with controlled IOP: a retrospective study

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Chan

et al. 2020

BMC Ophthalmol

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Background: To investigate the long term surgical outcomes of cataract surgery in severe and end stage glaucoma patients with preoperative intraocular pressure less than 21 mmHg, and to detect the associated factors. Methods: A retrospective study of primary angle closure glaucoma patients was conducted on who underwent cataract surgery or combined with goniosynechialysis from March 2015 to April 2018. Main outcome measures were visual acuity, intraocular pressure, number of glaucoma medications and complications. Results: Sixteen patients (19 eyes) were included. The mean age was 64.89 ± 11.68 years and the mean followed up duration was 21.89 ± 7.85 months. The final visual acuity was significantly improved from 0.69 ± 0.55 to 0.46 ± 0.52 logMAR, within 12 (63.2%) eyes improved, 4 (21.1%) eyes kept unchanged, and 3 (15.8%) eyes reduced. Linear regression analysis indicated that higher mean deviation, higher visual field index and lower glaucoma stage associated with better final visual acuity (r = − 0.511, r = − 0.493, r = 0.537 respectively). Moreover, the final number of medications were reduced from 1.26 ± 0.99 to 0.26 ± 0.56 (p < 0.01). The mean intraocular pressure was not significantly reduced with the final IOP of 14.48 ± 3.74 mmHg (p = 0.97). While the eyes with intraocular pressure above 15 mmHg was decreased to 6 (31.6%) eyes compared to 10 (52.6%) eyes at baseline. Moreover, the number of eyes free of medications was increased from 4 (21.1%) preoperatively to 15 (78.9%) eyes postoperatively. Conclusions: Final visual acuity was significantly improved in the severe and end stage primary angle closure glaucoma patients and the number of eyes came off medications increased by 57.8% after cataract surgery. Preoperatively, the glaucoma stage, mean deviation and visual field index are important parameters to predict the final visual acuity after cataract surgery.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 89%