Impact of peripheral anterior synechiae on the outcome of combined phacoemulsification, goniosynechialysis and goniotomy for primary angle-closure glaucoma and cataract: a multicenter observational study

Fengbin Lin; Yingzhe Zhang; Xiaomin Zhu; Ping Yu; Sujie Fan; Aiguo Lv; Xiaoyan Li; Li Tang; Yao Zhang; Guangxian Tang; Xiaowei Yan; Lan Lu; Meichun Xiao; Huiping Yuan; Wulian Song; Minwen Zhou; Xiaohuan Zhao; Xin Nie; Mengfei Liao; Yunhe Song; Zhenyu Wang; Weirong Chen; Keith Barton; Ki Ho Park; Tin Aung; Dennis S C Lam; Robert N Weinreb; Clement C Tham; Liuzhi Zeng; Lin Xie; Ningli Wang; Xiulan Zhang; PVP study group

doi:10.1097/IJG.0000000000002435

Impact of peripheral anterior synechiae on the outcome of combined phacoemulsification, goniosynechialysis and goniotomy for primary angle-closure glaucoma and cataract: a multicenter observational study

J Glaucoma. 2024 May 21. doi: 10.1097/IJG.0000000000002435. Online ahead of print.

Authors

Fengbin Lin¹, Yingzhe Zhang¹, Xiaomin Zhu², Ping Yu³, Sujie Fan⁴, Aiguo Lv⁴, Xiaoyan Li⁴, Li Tang⁵, Yao Zhang⁵, Guangxian Tang⁶, Xiaowei Yan⁶, Lan Lu⁷, Meichun Xiao⁷, Huiping Yuan⁸, Wulian Song⁸, Minwen Zhou⁹, Xiaohuan Zhao⁹, Xin Nie¹⁰, Mengfei Liao¹⁰, Yunhe Song¹, Zhenyu Wang¹, Weirong Chen¹, Keith Barton¹¹, Ki Ho Park¹², Tin Aung¹³, Dennis S C Lam¹⁴, Robert N Weinreb¹⁵, Clement C Tham¹⁶, Liuzhi Zeng³, Lin Xie², Ningli Wang¹⁷, Xiulan Zhang¹; PVP study group

Affiliations

¹ State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
² Department of Ophthalmology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China.
³ Department of Ophthalmology, Chengdu First People's Hospital, Chengdu 610095, China.
⁴ Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China.
⁵ Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, China.
⁶ Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang 050030, China.
⁷ Department of Ophthalmology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province 350001, China.
⁸ Department of Ophthalmology, The 2nd Affiliated Hospital, Harbin Medical University, Harbin 150086, China.
⁹ Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China.
¹⁰ Department of Ophthalmology, Chongqing People's Hospital, Chongqing 401121, China.
¹¹ NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK.
¹² Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
¹³ Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.
¹⁴ The International Eye Research Institute, The Chinese University of Hong Kong (Shenzhen), Shenzhen, China.
¹⁵ Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, CA, USA.
¹⁶ Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
¹⁷ Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.

PMID: 38767510
DOI: 10.1097/IJG.0000000000002435

Abstract

Purpose: To evaluate the impact of the extent of peripheral anterior synechiae (PAS) on the effectiveness and safety of combined phacoemulsification (PEI), goniosynechialysis (GSL), and goniotomy (GT) in eyes with primary angle-closure glaucoma (PACG) and cataract.

Patients and methods: This study included patients diagnosed with PACG and cataract who underwent combined PEI and 120 degrees GSL plus GT (PEI+GSL+GT) between April 2020 and October 2022 at 10 ophthalmic institutes. Eligible patients were divided into three groups based on the extent of PAS: 180°≤PAS<270°, 270°≤PAS<360°, and PAS=360°. Data on intraocular pressure (IOP), the number of ocular hypotensive medications, and complications were collected and compared. The study defined complete success as postoperative IOP within the 6-18 mmHg range and a 20% reduction from baseline without the use of topical medications. Qualified success was defined in the same way as complete success, but it allowed for the use of ocular hypotensive medications.

Results: Three hundred and four eyes of 283 patients were included. The mean follow-up was 12.50±1.24 months. All groups experienced a significant reduction in IOP after the surgery (P <0.05). There were no significant differences in final IOP, number of medications, and cumulative complete and qualified success rates among the three groups (P >0.05). The groups with 270°≤PAS<360°had a higher frequency of hyphema compared to 180°≤PAS<270° (P = 0.044).

Conclusions: PEI+GSL+GT has proven to be an effective treatment for PACG with cataract over one year period. However, the outcome was not correlated with preoperative extent of PAS.

Prcis: The combination of phacoemulsification, goniosynechialysis and goniotomy is an effective treatment for primary angle-closure glaucoma patients with cataract, and this is not linked to the extent of preoperative peripheral anterior synechiae.