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Our experience of combined lens extraction and goniosynechialysis in acute angle closure and primary angle closure glaucoma

Poster Details

First Author: T.Bader UK

Co Author(s):    R. Lee   D. Attlee   D. Lindfield   A. Kulkarni     

Abstract Details


To assess the effect of combined phacoemulsification & goniosynechialysis on intraocular pressure and medication requirement in patients with acute angle closure and primary angle closure glaucoma.


King's College Hospital, London, United Kingdom


A retrospective review of 12 patients and 13 eyes who underwent combined lens extraction and goniosynechialysis between May 2011 - October 2013 at one centre. Primary outcome measures included intraocular pressure and requirement for drops. Complete success was defined as ≥ 20% IOP reduction and absolute postoperative IOP ≤21 mmHg with no drops, qualified success ≥ 20% IOP reduction and absolute IOP ≤21 with a requirement for IOP lowering medications.


Retrospective data was collected on consecutive patients undergoing this procedure. There were 3 cases of acute angle closure and 10 primary angle closure glaucoma. Cataract density ranged from NS+ to NS+++, 62% of patients had NS++. Mean follow-up was 8 months (to date), range 2 months to 27 months. Mean preoperative IOP was 26mmHg (SD 7.3). Mean postoperative intraocular pressure was lowered to 15mmHg (SD 1.6). The difference between pre and post op IOP was statistically significant (p < 0.005). Mean eye drop medication usage was lowered to 1 drop (SD 1). The mean pre op number of drops was 2 (SD 1.15), with 5 patients on Diamox tablets also. Complete success was observed in 23% cases, qualified success in 54%. Patients with documented acute symptomatic angle closure had higher preoperative intraocular pressure and a larger intraocular pressure fall post op (from a mean of 34 mmHg to 14 mmHg) compared to the non acute group (23 mmHg to 15 mmHg).


Combined phacoemulsification and goniosynechialysis reduces intraocular pressure and medication requirements for patients with angle closure glaucoma. The procedure is more effective in eyes with an acute presentation of angle closure. Further work is required to determine if chronicity and extent of PAS have an impact on outcomes. Financial Disclosure: None FINANCIAL INTEREST: NONE

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