One-Year Results of a Multicenter Study: Intraocular Pressure–Lowering Effect of Combined Phacoemulsification, Goniosynechialysis, and Goniotomy for Cases of Advanced Primary Angle-Closure Glaucoma With Cataract

Abstract

Purpose: To evaluate the intraocular pressure (IOP)-lowering effect of the combination of phacoemulsification with intraocular lens implantation (PEI), goniosynechialysis (GSL), and goniotomy (GT) in eyes of advanced primary angle-closure glaucoma (PACG) with cataract. Design: Multicenter observational study. Methods: We enrolled 83 eyes of 83 patients with advanced PACG who received combined PEI+GSL+GT at 8 ophthalmic institutes. Each patient was assessed before treatment and at 1, 7 days, 1, 3, 6, and 12 months postsurgery. The criteria for complete success were IOP within 6 to 18 mm Hg and at least 20% of reduction in IOP from baseline without ocular hypotensive medications or reoperation. The definition of qualified success was similar to that of complete success, except for the need for ocular hypotensive medications. The potential prognostic factors for surgical success were investigated using a multivariate logistic model. Results: All participants completed 1 year of follow-up. Complete and qualified success were achieved in 74 (89.1%) and 79 (95.2%) of 83 eyes, respectively. The mean preoperative and postsurgical IOPs were 27.4±7.3 and 14.2±2.6 mm Hg, respectively. Participants used an average of 2.0 and 0.3 types of ocular hypotensive medications before and after surgery, respectively. The chief complications included hyphema (n=9), IOP spike (n=9), and corneal edema (n=8). None of the eyes required reoperation or developed vision-threatening complications. Multivariate analysis showed that older age was associated with a higher probability of complete success (odds ratio=1.13; 95% CI: 1.02–1.25; P=0.020). Conclusions: The 1-year results of combination of PEI+GSL+GT in treating advanced PACG cases with cataract appear to be safe and effective. Further large-scale multination and multicenter studies are warranted.

Minimally Invasive Glaucoma Surgery: Latest Developments and Future Challenges

“…A recent prospective multicenter observation study that involved 83 eyes of 83 patients with advance PACG showed that combined phacoemulsification, GSL, and GT was a safe and effective approach to reduced IOP and medication use. 194 In the 1-year follow-up period, the mean IOP was reduced from 27.4 ± 7.3 mm Hg to 14.2 ± 2.6 mm Hg, and the average number of medications were reduced from 2.0 to 0.2 types of medications. The complete and qualified success rates were 89.1% and 95.2%, respectively.…”

“…Video courtesy of Xiulan Zhang, MD, PhD, Zhongshan Ophthalmic Center, Guangzhou, China, Supplemental Digital Content 2, http://links.lww.com/APJO/A297. [194][195][196][197][198] ; videos on GT and GT + PEI for POAG and POAG + cataract, respectively, are also attached here for reference Video 3, GT alone, and Video 4, PEI + GT. Video courtesy of Xiulan Zhang, MD, PhD, Zhongshan Ophthalmic Center, Guangzhou, China, Supplemental Digital Content 3, http://links.lww.…”

Safety and Efficacy of Goniotomy following Failed Surgery for Glaucoma

“…[7][8][9] Goniotomy (GT) or ab interno trabeculotomy, a type of MIGS, has been shown to be safe and effective in the treatment of both primary open angle glaucoma (POAG) 10,11 and primary angle closure glaucoma (PACG). 12,13 However, for eyes with previously single or multiple failed surgery for glaucoma, the evidence on the safety and efficacy of GT is still limited. Therefore, we investigated the safety and efficacy of GT in eyes with prior single or multiple failed surgery for glaucoma.…”

Re-establishment of the Physiological Pathway of Aqueous Humor Drainage in Primary Angle-Closure Glaucoma: Phacoemulsification, Goniosynechialysis, and Goniotomy

“…In general, it should include a course of anti-inflammatory and prophylactic antimicrobial eye drops with variable use of IOPlowering medication and careful monitoring of the postoperative condition. Song et al 20 avoided postoperative IOP spike by restricting topical steroid use within 7 days, followed by topical nonsteroidal anti-inflammatory drug eye drops. While the authors believed this early steroid withdrawal step might be critical in preventing IOP spikes, the underlying mechanisms and postoperative regimen require further elucidation.…”

“…This issue of APJO covers a 1-year multicenter prospective case series of 83 advanced PACG patients who received combined PEI+GSL+GT in China by Song et al 20 The results showed that PEI+GSL+GT could effectively reduce IOP (mean IOP decreased from the preoperative 27.4 ± 7.3-14.2 ± 2.6 mm Hg at 1 y) and medication use (the types of ocular hypotensive medication was reduced from a mean of 2.0 at the preoperative period to 0.3 at 1 y) with a relatively low rate of reversible complications (9 hyphema, 9 IOP spike, and 8 corneal edema), though the long-term efficacy required future investigation. Indeed, the same study group is conducting a randomized controlled trial to compare the surgical outcomes of phacotrabeculectomy versus PEI+GSL+GT.…”