A comparison study on goniosynechialysis+ phacoemulsification versus simple phacoemulsification for CPACG with PAS≤180° combined cataract

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 (F_group=1.569, P=0.223). A significant difference was found in IOP among various time points in different groups (F_time=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 (F_group=1.996, P=0.172), however, a significant difference was found in BCVA among different time points in both groups (F_time=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.

Goniosynechialysis; Phacoemulsification; Chronic primary angle-closure glaucoma; Peripheral anterior synechia