Surgical outcome and safety of peripheral iridectomy plus goniosynechialysis and goniotomy in the treatment of advanced primary angle-closure glaucoma

Authors: Lin Fengbin,  Lu Ping,  Song Yunhe,  Gao Xinbo,  Zhang Yingzhe,  Nie Xin,  Peng Yuying,  Li Xiaoyan,  Zhu Xiaomin,  Zhang Hengli,  Zhang Yi,  Xie Lin,  Tang Guangxian,  Tang Li,  Fan Sujie,  Zhang Xiulan
DOI: 10.3760/cma.j.cn115989-20220819-00383
Published 2023-02-10
Cite as Chin J Exp Ophthalmol, 2023, 41(2): 134-139.

Abstract                              [Download PDF] [Read Full Text]

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.

Key words:

Glaucoma, angle-closure; Surgery; Multicenter study; Goniotomy; Goniosynechialysis; Peripheral iridectomy; Effectiveness; Safety

Contributor Information

Lin Fengbin

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, ChinaGlaucoma, angle-closure; Surgery; Multicenter study; Goniotomy; Goniosynechialysis; Peripheral iridectomy; Effectiveness; Safety

Lu Ping

Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China

Song Yunhe

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

Gao Xinbo

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

Zhang Yingzhe

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

Nie Xin

Department of Ophthalmology, People’s Hospital of Chongqing, Chongqing 401120, China

Peng Yuying

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

Li Xiaoyan

Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China

Zhu Xiaomin

Department of Ophthalmology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China

Zhang Hengli

Department of Ophthalmology, Shijiazhuang People’s Hospital, Shijiazhuang 050000, China

Zhang Yi

Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, China

Xie Lin

Department of Ophthalmology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China

Tang Guangxian

Department of Ophthalmology, Shijiazhuang People’s Hospital, Shijiazhuang 050000, China

Tang Li

Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, China

Fan Sujie

Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China

Zhang Xiulan

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

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