ESCRS - PO641 - Phacoemulsification Plus Gonyosynechialysis For Recent Acute Primary Angle Closure

Purpose

Analyze the effectiveness of goniosynechiolysis combined with phacoemulsification cataract surgery in patients with recent acute primary angle closure (APAC).

Goniosynechiolysis is a surgical procedure consisting of the release of peripheral anterior synechiae by opening the areas of angle-closure synechia, with the aim of restoring the function of the trabecular meshwork. The technique is often associated with cataract surgery.

Setting

Goniosynechiolysis is a surgical procedure consisting of the release of peripheral anterior synechiae by opening the areas of angle-closure synechia, with the aim of restoring the function of the trabecular meshwork. The technique is associated with cataract surgery.

Methods

A retrospective single-center study.

Thirty-five eyes from 30 patients who had previously experienced APAC in the previous year underwent phacoemulsification and goniosynechiolysis surgery. Demographic data (gender, age), intraocular pressure (IOP) measured before surgery, as well as six months post-surgery, were analyzed.

Goniosynechiolysis is performed using a direct gonioscopy lens and a Koch spatula, with good visualization of the iridocorneal angle achieved through positioning of the patient's head, microscope tilt, and avoiding hydration of the corneal incisions. The 180-220º inferior angle was treated by inserting the spatula through the incisions and gently pushing the base of the iris posteriorly, while observing the angle opening.

Results

The mean IOP reduction at 6 months postoperatively was 53.85%, with a mean IOP of 13.80 mmHg (SD 3.65) and an average of 0.55 (SD 0.99) hypotensive medications. In cases where the IOP reduction was less than 20% at 6 months, the preoperative mean IOP was of 10.67 mmHg, and surgery was indicated due to the presence of a clinically significant cataract.

The mean age at presentation of APAC was 62 years, with a range from 38 to 85 years. The mean IOP at APAC presentation was 57.50 mmHg (SD 3.54). Laser peripheral iridotomy was successfully performed and effective as the initial treatment in 24 eyes, while 11 eyes required argon iridoplasty to resolve the condition. The average time from APAC onset to surgery was 53 days (SD 9.9).

Conclusions

Goniosynechiolysis combined with phacoemulsification is a safe technique that effectively releases peripheral anterior synechiae, enabling intraocular pressure (IOP) control in patients with recent acute primary angle closure (APAC). This approach provides a promising solution for managing IOP while addressing the cataract condition.

As many cataract surgeons may encounter patients who have experienced recent APAC, it is important to be familiar with this technique. Understanding goniosynechiolysis combined with phacoemulsification can help manage these cases effectively, restoring intraocular pressure control while addressing the cataract condition.