Efficacy Of Phacoemulsification And Phacoemulsification Combined With Goniosynechialysis In Surgical Treatment Of Chronic Angle-Closure Glaucoma: 2-Years Study

To study the degree of angle opening and the decrease of intraocular pressure in primary angle-closure glaucoma (PACG) after cataract phacoemulsification (Phaco) and cataract phacoemulsification with goniosynechialysis (Phaco + GLS).

The study involved 28 eyes with primary chronic PACG. There were two groups, group 1 of 15 patients undergoing Phaco with posterior chamber IOL implantation, and group 2 of 13 patients undergoing Phaco with IOL implantation and GLS. The patients were followed for 24 months. Phaco was indicated in cases with IOP above 22 mmHg, appositional anterior chamber angle closure, and optic neuropathy; Phaco with GSL was indicated in cases of synechial angle closure and IOP above 22 mmHg. 

In group 1 after Phaco, postoperative anterior chamber angle opening was > 20 ° in all quadrants. Postoperative IOP after 24 month follow-up it decreased by 32,6 % from the preoperative levels. Trabeculectomy was performed on one patient 8 months after surgery for decompensated IOP

In group 2 after Phaco+GSL, anterior chamber angle opened at least to 20° in three or more quadrants in all cases. Postoperative IOP after 24 month follow-up it decreased by 33.0% from the preoperative levels. No secondary interventions for intraocular hypertension were performed in this group.

Thus, phacoemulsification is an efficient procedure for PACG and appositional angle closure, leading to reopening of the anterior chamber angle with significant IOP reduction. Phacoemulsification alone does not lead to reopening of anterior chamber angle in cases with synechial angle closure, necessitating a combined surgery of phacoemulsification with GSL. Intraoperative assessment for synechial anterior chamber angle closure provides clear-cut indications for GSL, thus improving the efficacy of surgical treatment of PACG