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AIM: To evaluate the efficacy of phacoemulsification with intraocular lens implantation(PEI)combined with goniosynechialysis(GSL)and goniotomy(GT)under direct vision with gonioscope in the treatment of advanced primary angle-closure glaucoma(PACG)combined with cataract.METHODS: Retrospective case series study. A total of 62 patients(65 eyes)with advanced PACG combined with cataract who were treated in the Second Hospital of Anhui Medical University from December 1, 2021 to March 31, 2023 were enrolled, and they were divided into two groups according to different surgical methods. The control group(32 cases, 33 eyes)received PEI+GSL, whereas the observation group(30 cases, 32 eyes)received PEI+GSL+GT. The intraocular pressure(IOP), best corrected visual acuity(BCVA)and the number of anti-glaucoma medications of the two groups before surgery and at 1 d, 1 wk, 1, 3, and 6 mo after surgery were evaluated. In addition, the visual field, cup-to-disc ratio(C/D), angle open range, anterior chamber depth, and average thickness of retinal nerve fiber layer(RNFL)were evaluated before and 6 mo after surgery.RESULTS: There were significant differences in IOP and lowering range of average IOP at 6 mo between the PEI+GSL+GT group(16.68±2.65, 11.12±8.53 mmHg)and the PEI+GSL group(18.71±2.51, 8.32±4.17 mmHg; P<0.05), and there was no difference in the rate of IOP reduction(44.57%±21.79% and 35.20%±17.94%, P>0.05). The number of anti-glaucoma medications, BCVA, anterior chamber depth, and angle closure range were improved in the two groups at 6 mo after operation(all P<0.01). The number of medication reductions and the range of angle opening at 6 mo after surgery in the PEI+GSL+GT group were significantly higher than those in the PEI+GSL group(P<0.05), and there was no difference in the other indicators between the two groups(all P>0.05). There was no difference in the mean deviation of visual field, C/D and average thickness of RNFL between the two groups at 6 mo after operation compared with those before operation(all P>0.05). The complete surgery success rate of the PEI+GSL+GT group was 81%(26/32), and the conditional success rate was 94%(30/32); while those rates of the PEI+GSL group were 58%(19/33)and 76%(25/33), respectively. There were statistical significance in the success rate of surgery between the two groups(complete success rate χ2=4.275, P=0.039; conditional success rate χ2=4.040, P=0.044). No vision-threatening complications and another surgery occurred in either group.CONCLUSION: The study showed that for patients with advanced PACG with cataract, PEI+GSL+GT is more effective than PEI+GSL.
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AIM: To investigate the clinical efficacy of femtosecond laser-assisted phacoemulsification combined with goniosynechialysis in the treatment of acute angle-closure glaucoma complicated with cataract.METHODS: A total of 53 patients(60 eyes)with primary acute angle closure glaucoma complicated with cataract admitted to our hospital from April 2020 to February 2021 were selected. They were divided into two groups according to the surgical method, with 28 cases(30 eyes)who were treated with femtosecond laser-assisted phacoemulsification combined with goniosynechialysis in group A, and 25 cases(30 eyes)who were treated with traditional cataract phacoemulsification combined with goniosynechialysis in group B. The effective phacoemulsification time(EPT)and cumulative dissipated energy(CDE)during surgery in two groups were recorded. Patients were followed up to 3mo after surgery, and the intraocular pressure, anterior chamber depth(ACD), best corrected visual acuity, corneal endothelial cell loss rate(ECL)and surgical complications were observed in both groups.RESULTS: The postoperative intraocular pressure was significantly decreased and ACD was significantly increased(all P<0.05), and there was no difference between the two groups(all P>0.05). The postoperative best corrected visual acuity of the two groups was significantly better than that before surgery(P<0.05), and group A was significantly better than group B at 1d after surgery(P<0.05). The EPT, CDE, ECL and incidence of complications(7% vs. 27%)in group A were significantly lower than those in group B(all P<0.05).CONCLUSION: Femtosecond laser-assisted cataract phacoemulsification combined with goniosynechialysis in the treatment of primary acute angle-closure glaucoma combined with cataract has a significant therapeutic effect, which can effectively improve surgical safety, reduce the rate of corneal endothelial cell loss, and have fewer complications.
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With high incidence, high disability rate and serious impact on patients' quality of life, advanced primary angle-closure glaucoma (PACG) with cataract is a severe eye disease in China and its main treatment method is surgery.Phacoemulsification cataract extraction and intraocular lens implantation (PEI) combined with trabeculectomy has been used to treat advanced PACG with cataract, but there are many postoperative complications.Recently, combined PEI, goniosynechialysis (GSL) and goniotomy (GT) has been proven to be a safe and effective surgical treatment for advanced PACG with cataract.At present, the combined PEI+ GSL+ GT surgery has been widely applied, but there is still a lack of uniform standards for its clinical application.Therefore, it is necessary to formulate a detailed and complete recommendation of the surgical procedures for PEI+ GSL+ GT, to standardize its application in clinical practice.Based on the analysis of the existing problems, some glaucoma experts in China have formulated detailed and complete operation norms, as well as expert recommendations on surgical indications and contraindications, anesthetic methods, surgical techniques and perioperative medication to standardize the application process of PEI+ GSL+ GT in clinical practice.
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Minimally invasive glaucoma surgery (MIGS) has been successfully incorporated in clinical practice in recent years.Increasing evidence shows that MIGS also plays an increasingly important role in the treatment of primary angle-closure glaucoma (PACG). Surgical peripheral iridectomy (SPI) plus goniosynechialysis (GSL) and goniotomy (GT), as a new procedure, has been proven to be safe and effective in the treatment of PACG with no or mild cataracts.However, there is still a lack of uniform standards for indications, surgical procedures, and perioperative medication.Therefore, it is necessary to formulate a detailed and complete expert recommendations on surgical procedures to standardize the application of combined SPI+ GSL+ GT in the treatment.Some experts in glaucoma treatment and management in China have discussed the current problems and developing trend in MIGS for PACG and put forward the expert recommendations of standard process, including indications, anaesthetic methods, surgical site, operating procedure and rational administration of drugs in perioperation, in order to standardize the medical process of clinicians using combined SPI+ GSL+ GT in PACG treatment and lay a foundation for better evaluation of the efficacy of MIGS.
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Objective:To evaluate the preliminary effectiveness and safety of surgical peripheral iridectomy (SPI) combined with goniosynechilysis (GSL) and goniotomy (GT) in the treatment of advanced primary angle-closure glaucoma (PACG).Methods:A multicenter observational case series study was performed.Thirty-five eyes of 27 patients with advanced PACG, who underwent SPI+ GSL+ GT with a follow-up of at least 6 months, were included from August 2021 to January 2022 at Zhongshan Ophthalmic Center, Handan City Eye Hospital, Shijiazhuang People's Hospital, West China Hospital of Sichuan University, and the Third Affiliated Hospital of Chongqing Medical University.The mean follow-up time was 9(7, 10) months.Pre- and post-operative best corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured with an ETDRS chart and a Goldmann applanation tonometer, respectively.The number of anti-glaucoma medications applied before and after surgery was recorded, and the complications after surgery were analyzed.Success rate of surgery was calculated.Complete surgical success was defined as an IOP of 5-18 mmHg (1 mmHg=0.133 kPa) and 20% reduction from baseline without anti-glaucoma medication or reoperation.Qualified success was defined as achieving criterion of complete success under anti-glaucoma medications.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Zhongshan Ophthalmic Center, Sun Yat-sen University (No.2021KYPJ177). Written informed consent was obtained from each subject.Results:The mean preoperative IOP was (30.83±8.87)mmHg, which was significantly decreased to (15.69±3.70)mmHg at 6 months after the surgery ( t=8.588, P<0.001), with a 44.00% (34.78%, 60.00%) decline of 13.00(8.00, 21.00)mmHg.The median number of anti-glaucoma medications was significantly reduced from 2(0, 3) preoperatively to 0 (0, 1) postoperatively ( Z=-3.659, P<0.001). The mean preoperative and postoperative 6-month BCVA were 0.80(0.63, 1.00) and 0.80(0.60, 1.00), respectively, showing no significant difference ( Z=-0.283, P=0.777). Complete surgical success rate was 62.86%(22/35), and the qualified success rate was 91.43%(32/35). Surgical complications mainly included hyphema (6/35), IOP spike (3/35), and shallow anterior chamber (4/35). There was no vision-threatening complication. Conclusions:SPI+ GSL+ GT is preliminarily effective and safe in the treatment of advanced PACG, which provides a new option for PACG.
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Minimally invasive glaucoma surgery (MIGS) has been successfully incorporated in clinical practice in recent years.Increasing evidence shows that it also plays an important role in the treatment of primary angle-closure glaucoma (PACG). Goniosynechialysis (GSL) is a key surgical procedure used by MIGS for PACG, which involves separating the peripheral anterior synechia and reopening the angle.However, there is still a lack of uniform standards for indications and surgical procedures.Therefore, it is necessary to formulate a detailed and complete expert consensus on surgical procedures to standardize the application of clinicians in the treatment.
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@#AIM: To observe the changes of visual acuity, intraocular pressure(IOP)and anterior chamber structure after phacoemulsification intraocular lens(IOL)implantation and goniosynechialysis in acute angle-closure glaucoma with cataract.<p>METHODS: A prospective study. Totally 80 eyes with acute primary angle-closure glaucoma(APACG)and cataract were selected in our hospital from August 2019 to February 2021. All study underwent phacoemulsification IOL implantation and goniosynechialysis. Visual acuity, IOP, anterior chamber distance(ACD), trabecular iris angle(TIA)and angle opening distance(AOD500)were measured before and 1wk, 1, 3 and 6mo after surgery. Four quadrant angle classifications of upper, lower, nasal and temporal were determined by Scheie classification method and the measured values were statistically analyzed.<p>RESULTS: The postoperative corrected visual acuity in 1wk, 1, 3 and 6mo were improved than preoperative, there were no statistically significant differences between each postoperative period(<i>P</i>>0.05). The IOP in postoperative 1wk, 1, 3 and 6mo were reduced than preoperative, there were not significantly different between each postoperative period(<i>P</i>>0.05). The ACD in postoperative 1wk, 1, 3 and 6mo were deepen than preoperative, there were not significantly different between each postoperative period(<i>P</i>>0.05). The TIA in postoperative 1wk, 1, 3 and 6mo were widened than preoperative, there were not significantly different between each postoperative period(<i>P</i>>0.05). The AOD500 in postoperative 1wk, 1, 3 and 6mo were increased than preoperative, there were not significantly different between each postoperative period(<i>P</i>>0.05). The depth of anterior chamber angle in four quadrants were deepened combined with the depth in postoperative 1wk, 1, 3 and 6mo(<i>P</i><0.05).<p>CONCLUSION: Phacoemulsification IOL implantation and goniosynechialysis in the treatment of acute angle-closure glaucoma with cataract can significantly improve visual acuity, increase the depth of central anterior chamber, open angle, reduce IOP. It is an effective and stable surgical method.
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@#AIM: To observe the clinical effect of femtosecond laser-assisted phacoemulsification combined with goniosynechialysis in the management of acute angle-closure glaucoma with cataract.<p>METHODS:Retrospective study. From March 2019 to April 2021, 34 eyes of 29 acute angle-closure glaucoma with cataract patients were performed femtosecond laser-assisted phacoemulsification combined with goniosynechialysis. Best corrected visual acuity(BCVA), intraocular pressure(IOP), grading of chamber angle, central anterior chamber depth, corneal endothelial cell count and central corneal thickness were mesaured and analyzed preoperatively and at 1d, 1wk, 1mo.The postoperative complications were analyzed.<p>RESULTS: There was a statistically significant difference between preoperative and postoperative BCVA at 1mo(<i>Z</i>= -5.126, <i>P</i><0.01). IOP at 1d, 1wk and 1mo were 16.72±2.12mmHg, 13.73±1.68mmHg and 12.87±3.54mmHg respectively, which were different from 28.67±4.13mmHg before surgery(all<i> P</i><0.01). The range of atrial angle adhesion at 1mo after the surgery was significantly reduced compared with preoperative(<i>t</i>=21.32, <i>P</i><0.01). The depth of central anterior chamber, the open distance of atrial angle and the included angle of trabecular iris at 1mo after the surgery were significantly greater than preoperative(<i>t</i>= -3.37,-3.68, -5.61, all <i>P</i><0.01). There were no significant differences in corneal endothelial cell count and central corneal thickness(<i>P></i>0.05). Postoperative satisfaction was high without serious complications.<p>CONCLUSION:Femtosecond laser-assisted phacoemulsification combined with goniosynechialysis may be an effective treatment option for acute angle-closure glaucoma complicated with cataract, is safe, effective and has fewer complications.
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Objective:To compare the efficacy of phacoemulsification+ goniosynechialysis (Phaco-GSL) and Phaco alone for chronic primary angle-closure glaucoma (CPACG) patients with peripheral anterior synechia (PAS)≤180° combined cataract.Methods:A cohort study was performed.Fifty-two eyes with CPACG in 40 patients who underwent Phaco-GSL and Phaco-alone in Peking Union Medical College Hospital from February 2014 to October 2018 were enrolled.The patients were divided into Phaco-GSL group (22 cases, 29 eyes) and Phaco-alone group (18 cases, 23 eyes) according to different surgeries.Goldmann applanation tonometer was used to measure intraocular pressure (IOP) before operation and 1 day, 1 week and 1, 3, 6, 12, 18 months after operation.Best corrected visual acuity (BCVA) was examined with a standard logarithmic visual acuity chart.The number of anti-glaucoma drugs was calculated in the follow-up duration.The change of PAS was observed by ultrasound biomicroscopy and indentation gonioscopy.The intra- and post-operative complications and their management were analyzed and compared.This research protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Peking Union Medical College Hospital (No.S-K1352). Written informed consent was obtained from each subject prior to any medical examination.Results:There was no significant difference in IOP between the Phaco-GSL group and the Phaco-alone group ( Fgroup=1.569, P=0.223). A significant difference was found in IOP among various time points in different groups ( Ftime=7.762, P<0.01). The IOP of the eyes were significantly reduced at various time points postoperatively in comparison with the preoperative IOP in each group (all at P<0.001). There was no significant intergroup difference in BCVA ( Fgroup=1.996, P=0.172), however, a significant difference was found in BCVA among different time points in both groups ( Ftime=95.737, P<0.01). The postoperative 6- and 18-month BCVA was significantly improved in comparison with before surgery in both groups (all at P<0.001). The number of anti-glaucoma medicines used was significantly decreased at postoperative 1, 6, 12, 18 months in comparison with preoperation in both groups (all at P<0.05), and the anti-glaucoma medicines used in the Phaco-GSL group was less than that in the Phaco-alone group at 6, 12 and 18 months after surgery (all at P<0.05). The ranage of PAS at 18 months after surgery was 45 (0, 90)° and 100 (90, 140)° in the Phaco-GSL group and Phaco-alone group, respectively.The range of PAS in the Phaco-GSL group at postoperative 1, 3, 6, 12, 18 months was significantly smaller than preoperation in the Phaco-alone group (all at P<0.05). The incidence of intra- and post-operative complications in the Phaco-GSL group was significantly higher than that in the Phaco-alone group ( P<0.001). Conclusions:Both Phaco-GSL and Phaco-alone can reduce IOP and improve visual acuity in CPACG with PAS≤180° combined cataract patients.Phaco-GSL can maintain the gonio open and reduce the use of anti-glaucoma medicines and show a good safety.
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@#AIM: To evaluate and compare the quality of life of patients submitted to phacoemulsification combined with goniosynechialysis(PPI+GSL)and trabeculectomy, and analyze the potentially involved variables.<p>METHODS: A perspective, randomized case-control study was conducted. Patients with acute primary angle-closure glaucoma(ACG)and early cataracts underwent PPI+GSL implantation(group A, <i>n</i>=29)and trabeculectomy(group B, <i>n</i>=30). The quality of life was assessed using the National Eye Institute 25-Item Visual Function Questionnaire(NEI-VFQ-25)before and 6mo after surgery. Intraocular pressure(IOP), best corrected visual acuity(BCVA), review frequency and the basic characteristics were recorded simultaneously.<p>RESULTS: Compared with preoperative status, the IOP in both groups was significantly decreased(all <i>P</i><005), and the BCVA was significantly increased in group A(<i>P</i><0.05), while did not differ significantly in group B(<i>P</i>>0.05). Besides, group B presented higher review frequency than group A(<i>P</i><0.05). Moreover, significant increases in postoperative scores were founded in the two groups respectively(all <i>P</i><0.05). Compared with group B, group A had better postoperative performance in items of general vision, ocular pain, long-distance activities, social functioning and role limitations(all <i>P</i><0.05). Besides, group A presented significantly higher net increases in postoperative total scores than group B(<i>P</i><0.05), which was positively associated with the degree of the BCVA recovery and negatively associated with review frequency(<i>R</i><sup>2</sup>=0.48, <i>F</i>=5.00, <i>P</i><0.05).<p>CONCLUSION: APACG patients with early cataracts, PPI+GSL determines better improvement in quality of life compared to trabeculectomy.
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@#AIM: To observe the safety and efficacy of phacoemulsification combined with goniosynechialysis in treatment of primary angle-closure glaucoma(PACG)with intraocular pressure out of control after trabeculectomy.<p>METHODS: We retrospectively reviewed 31 cases(32 eyes)of acute or chronic PACG with uncontrolled intraocular pressure from June 2015 to April 2019. The history of trabeculectomy was 3mo to 12a. All of them were complicated with different degrees of cataract. Phacoemulsification combined with intraocular lens implantation and goniosynechialysis were performed in all patients. The patients were followed up for 6mo. The IOP, the best corrected visual acuity(BCVA), the depth of central anterior chamber and the peripheral anterior synechia(PAS)of anterior chamber angle were observed preoperatively and 1, 3 and 6mo postoperatively. The corneal endothelial cell count and the thickness of the retinal nerve fiber layer(RNFL)were observed 6 months after the operation. The complications during and after operation were observed. <p>RESULTS: The IOP was significantly decreased on 1wk, 1, 3, 6mo postoperative(14.38±3.04, 18.26±3.12, 15.21±2.84, 15.42±3.09mmHg)compared with preoperative(36.52±12.26mmHg)(<i>P</i><0.01). The BCVA(LogMAR)(0.241±0.148)was increased postoperative after 6 mo compared with preoperative(0.678±0.297). The depth of central anterior chamber was increased on 1, 3, 6mo postoperative(4.18±0.22, 4.21±0.24, 4.16±0.25mm)compared with preoperative(1.45±0.25mm). All of above observation indexes was significantly different from that of preoperation(<i>P</i><0.01). The angle of anterior chamber was widened and the range of PAS was reduced. The PAS did not increase after 3mo. There was no statistical difference between preoperative and postoperative about the corneal endothelial cells count and the mean or the four quadrant RNFL thickness(<i>P</i>>0.05). Corneal edema in 7 eyes and anterior chamber inflammatory exudation in 3 eyes disappeared within 7d after treatment. The IOP of 3 patients(3 eyes)with chronic PACG was 21-30mmHg which was controlled by 1 to 3 anti-glaucoma eye drops.<p>CONCLUSION: Phacoemulsification combined with goniosynechialysis is a safe and effective method in the treatment of PACG combined with cataract with intraocular pressure out of control after trabeculectomy.
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@#The lens plays a crucial part in the etiology of primary angle-closure glaucoma(PACG). The changes in the thickness and position of the lens have been related to common structural deviations observed in PACG eyes such as: shallow anterior chamber, pupillary block and crowded anterior chamber angle. Lens extraction has long been used to treat PACG, which combined with anti-glaucoma surgeries remains a commonly employed therapy. This article aims to summarize the medical outcome and role of phacoemulsification with or without anti-glaucoma surgeries in the treatment of PACG.
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@#AIM: To assess the clinical efficacy of phacoemulsification, intraocular lens implantation with goniosynechialysis(PEI+GSL)for acute angle closure glaucoma(AACG)and cataract with extensive angle closure synechiae.<p>METHODS: A retrospective study, we studied 35 eyes of 32 patients with AACG and cataract in our hospital. The extent of anterior chamber angle-closure synechiae was defined as an eye with >180°. All patients underwent PEI+GSL and completed an ophthalmologic examination including vision, intraocular pressure(IOP), anterior chamber depth(ACD), angle-opening distance(AOD500), trabecular-iris space area(TISA500)were observed at 1d, 1wk, 1mo and 3mo after cataract surgery. The angle closure range and retinal nerve fiber layer(RNFL)thickness changes at postoperative 1mo and 3mo were observed, and recorded complications.<p>RESULTS: Postoperative 3mo BCVA(0.334±0.154)and IOP(14.63±3.59mmHg)were improved compared with preoperative(0.914±0.290, 42.54±8.06mmHg)(<i>P</i><0.05). ACD(3.203±0.214mm), OCT angle parameters AOD500 and TISA500(0.308±0.014, 0.315±0.015mm, 0.134±0.013, 0.139±0.018mm2)were significantly increased compared with preoperation. The extent of angle closure with gonioscopy(72.32±28.33°)decreased compared preoperation(215.29°±30.66°), and RNFL thickness thinner than preoperation(<i>P</i><0.001). Changes in AOD500 and TISA500 for both nasal and temporal were negatively correlated with IOP, but not with changes in ACD, and no significant complications occurred in the 3mo after surgery.<p>CONCLUSION: The treatment of PEI+GSL can improve vision, deeper ACD and effectively open ACA in the early stage, thus controlling IOP.
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@#AIM: To summarize the characteristics and treatment of primary acute angle-closure glaucoma during the outbreak of corona virus disease 2019(COVID-19)in Wuhan.<p>METHODS: Five patients(9 eyes)with primary acute angle-closure glaucoma(APACG)of our hospital were enrolled. Eight eyes with sustained high intraocular pressure(IOP)were given phacoemulsification with goniosynechialysis and one eye in preclinical phase was given YAG laser iridectomy from March 3-20, 2020. The preoperative and postoperative IOP, visual acuity, hospitalization days and complications were reviewed and analyzed.<p>RESULTS: Three out of five APACG cases were binocular attack. The onset time was 12-40(25.2±11.82)d. The IOP(48.38±3.22mmHg)of eight eyes decreased significantly after surgeries(12.63±1.68mmHg), the difference was statistically significant(<i>t</i>=12.192, <i>P</i><0.01). The hospitalization time was 2-6(3.8±1.48)d. No COVID-19 infection or severe complications were observed. <p>CONCLUSION:During the epidemic of COVID-19, phacoemulsification with goniosynechialysis is able to reduce IOP of APACG patients who suffered from longer, heavier and binocular attack in the epidemic area effectively and safely. Strict prevention management can effectively ensure the safety of medical staff and patients, but also increase the difficulty of the surgeries meanwhile.
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@#AIM: To evaluate the efficacy of phacoemulsification and intraocular lens implantation combined with goniosynechialysis in the treatment of chronic angle-closure glaucoma.<p>METHODS: Thirty-three patients(35 eyes)with primary chronic angle-closure glaucoma and cataract were enrolled in the Department of Ophthalmology, Xi'an First Hospital from May 2018 to November 2018. The best corrected visual acuity, intraocular pressure, central anterior chamber depth, angle-opening distance at 500μm from the scleral spur, trabecular iris angle, angle closure or adhesion were compared between preoperative and postoperative 6mo.<p>RESULTS: The best corrected visual acuity of 34 eyes(97%)was improved after operation. 27 eyes(77%)did not need any intraocular pressure lowering drugs after operation, and the intraocular pressure was kept below 21mmHg. The average value of anterior chamber depth, angle-opening distance at 500μm from the scleral spur and trabecular iris angle(2.04±0.31mm, 0.132±0.033μm, 15.44°±3.10°)before operation were significantly lower than the postoperative mean values(3.26±0.29mm, 0.407±0.038μm, 34.26°±3.60°). The range of angle closure or adhesion decreased after operation, and the difference was statistically significant. <p>CONCLUSION: Phacoemulsification with intraocular lens implantation and goniosynechialysis is an effective way to treat primary chronic angle-closure glaucoma.
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A 48-year-old lady presented with bilateral symptomatic uveitis. She had bilateral cosmetic iris implantation 4 years ago. She underwent bilateral cosmetic iris explantation and goniosynechialysis to open up areas of angle compromise. This patient presented before significant angle compromise. This case report also serves to highlight the serious potential risks associated with cosmetic iris implantation. Patients with cosmetic iris implants should be warned of the potential complications and advised explantation at the earliest.
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Purpose: To compare surgical outcomes of patients after phacoemulsification with goniosynechialysis (phaco/GSL) versus phaco with GSL and endocyclophotocoagulation (phaco/GSL/ECP) in patients with chronic angle closure glaucoma (CACG) through 12-month follow-up. Methods: A retrospective, nonrandomized, comparative case series was performed. Patients with CACG who underwent phaco in combination with either GSL alone (group 1) or GSL with ECP with intracameral injection of kenalog (group 2) from 2011 to 2018 were included. Group 1 included 6 eyes of 6 patients and group 2 included 11 eyes of 10 patients. All surgeries were performed by a single surgeon (RSA). Primary outcome measures included changes in intraocular pressure (IOP), visual acuity (VA), failure based on IOP (>18 or <6 mmHg at 1 year), and secondary operative procedures and complication rates. Data were analyzed using a paired two-tailed T-test. Results: The mean preoperative IOP decreased from 23.5 ± 11.2 to 14.2 ± 2.4 mmHg (P < 0.0073) in group 1 and 24.4 ± 8.2 to 14.5 ± 2.7 mmHg (P < 0.0001) in group 2. The mean % IOP reduction was 33.7% in group 1 and 34.2% in group 2. The mean improvement in VA (logMAR units) was 0.24 (P = 0.085) in group 1 and 0.13 (P = 0.657) in group 2. The mean number of topical meds decreased from 2.50 ± 1.76 to 1.80 ± 1.64 in group 1 (P = 0.513) and from 2.82 ± 1.25 to 1.17 ± 0.98 in group 2 (P = 0.014). Conclusion: Phaco/GSL and phaco/GSL/ECP both achieve a significant reduction in IOP without the complications associated with traditional glaucoma filtration surgeries.
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@#AIM: To investigate the influence of high perfusion irrigation during phacoemulsification on the postoperative visual function of patients with acute angle-closure glaucoma(AACG).<p>METHODS: Totally 35 patients(37 eyes)with AACG with cataract were included to do the surgery of phacoemulsification with goniosynechialysis. They have been followed up for 6mo. The preoperative and postoperative(3mo and 6mo)best corrected visual acuity(BCVA), intraocular pressure, mean sensitivity(MS), mean defect(MD), and square root loss variance(sLV)were measured and compared.<p>RESULTS: Compared with preoperative results, 3mo and 6mo BCVA were significantly improved and intraocular pressure was significantly reduced after operation, with statistically significant differences(<i>P</i><0.001). There was no statistically significant difference between groups after operation(<i>P</i>>0.05). After surgery, 3mo and 6mo MS increased significantly, MD and sLV decreased significantly, and the difference was statistically significant(<i>P</i><0.001). There was no statistically significant difference between the groups after surgery(<i>P</i>>0.05).<p>CONCLUSION: The high perfusion irrigation during phacoemulsification does not damage the visual function of patients with AACG.
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@#AIM: To analyze the efficacy and safety of goniosynechialysis or trabeculectomy combined with phacoemulsification(Phaco)in the treatment of primary angle-closure glaucoma(PACG)and coexisting cataract.<p>METHODS: A retrospective study. A total of 108 eyes of 96 PACG patients with age-related cataract admitted to our hospital from March 2013 to February 2018 were collected. Goniosynechialysis combined with Phaco(group A)was performed in 50 cases(54 eyes), and trabeculectomy combined with Phaco(group B)in 46 cases(54 eyes). The best corrected visual acuity, intraocular pressure, central anterior chamber depth, corneal endothelial cell count, failure rate, recurrence rate, operation time and average hospitalization days were compared between the two groups.<p>RESULTS: After at least 12mo of follow-up(till February 2019), the best corrected visual acuity of the two groups was significantly improved, and the intraocular pressure was significantly lower than preoperation(<i>P</i><0.01). Intraocular pressure in group B was significantly lower than that in group A postoperatively(<i>P</i>=0.004), while the best corrected visual acuity in group B was lower than that in group A(<i>P</i>=0.012). The central anterior chamber depth of the two groups was significantly deeper than pre-operation(<i>P</i><0.01), but there was no significant difference between the two groups(<i>P</i>=0.231). At the last follow-up, there was no significant difference in the percentage of hexagonal cells(<i>P</i>>0.05). The operation time of group A was shorter(<i>P</i>=0.022), and the average hospitalization days were significantly lower than those of group B(<i>P</i><0.001). There was no significant difference in the failure rate(<i>P</i>=0.243)and recurrence rate(<i>P</i>=0.113)between the two groups.<p>CONCLUSION: Goniosynechialysis combined with Phaco in the treatment of PACG and coexisting cataract has similar efficacy and safety to trabeculectomy combined with Phaco. The former may achieve better visual acuity, shorter operation time and shorter hospitalization time, while the latter has lower failure rate and recurrence rate, which is more suitable for patients with chronic PACG.
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@#AIM: To explore the effect of phacoemulsification combined with goniosynechialysis or trabeculectomy on haemodynamics in patients with primary angle-closure glaucoma(PACG)and cataract.<p>METHODS: Totally 94 patients(94 eyes)with PACG and cataract who were admitted to Bazhong Central Hospital from January 2015 to June 2017 were divided into phacoemulsification and goniosynechialysis group(Observation group)and phacoemulsification with trabeculectomy group(Control group)by random number table method, 47 cases in each group. The indexes of curative effect were compared between the two groups.<p>RESULTS:The peak systolic velocity(PSV)and end diastolic velocity(EDV)of Observation group were larger than those of Control group at 1mo and 3mo after surgery. The resistance index(RI)of Observation group was significantly less than that of Control group at 3mo after surgery, while anterior chamber depth and open degree of angle were larger than those of group B(<i>P</i><0.05).<p>CONCLUSION:Both goniosynechialysis or trabeculectomy combined with phacoemulsification can effectively reduce intraocular pressure, and promote visual recovery. But goniosynechialysis can better promote opening of angle, and improve hemodynamics.