Regardless of the extent of a patient’s preoperative peripheral anterior synechiae (PAS), researchers say combined phacoemulsification and goniosynechialysis (phaco-GSL) can effectively manage primary angle-closure disease (PACD) and control intraocular pressure (IOP), according to a study published in the Journal of Glaucoma.
The investigators conducted a retrospective analysis that reviewed a total of 79 eyes of 67 patients who received phaco-GSL. The researchers divided the patients into 2 groups according to the extent of PAS, eyes with PAS of 180˚ or below, and eyes with PAS above 180˚. The researchers evaluated changes in IOP, the number of anti-glaucoma drugs, intraoperative mechanical separation of PAS, and range of re-PAS during the last follow up at 12 months or more.
The team found that eyes with PAS above 180 degrees presented with higher IOP and required more anti-glaucoma drugs (P =.008 and P =.004, respectively) at baseline. At the final follow-up visit, they observed that the PAS range, IOP, and number of anti-glaucoma medications were reduced both in groups.
They found that the range of mechanical separation intraoperatively and re-PAS postoperatively were both larger in eyes with PAS above 180 degrees (P =.002 and P <.001, respectively) and that the postoperative re-PAS range was positively correlated with the range of mechanical separation (R2=0.17; P =.002).
The study shows that the complete success rates at 12, 24, 36, and 48 months were 86.8%, 71.1%, 71.1%, and 71.1% in eyes with PAS of 180˚ or below, and 80.5%, 74.6%, 69.9%, and 69.9% in eyes with PAS above 180˚. The qualified success rates at those timepoints were 100%, 96.6%, 92.0%, and 92.0% in eyes with PAS of 180˚or below; and 100%, 89.5%, 85.1%, and 85.1% in eyes with PAS above 180˚.
The investigators explain that, with the combined phaco-GSL approach, “IOP can be effectively controlled, and visual acuity can be improved after surgery regardless of the range of PAS before surgery. Moreover, IOP was controlled at a similar level after surgery. There will be a certain range of re-PAS after surgery. The more PAS before surgery, the greater range of re-PAS after surgery. However, there was no significant difference in the proportion of re-PAS range between the 2 groups.”
Limitations of the study included the retrospective design, lack of documentation of intraoperative procedure of GSL in a small number of patients, and potential selection bias, with patients who completed regular follow ups potentially having more severe cases.
Wei L, Fu L, Nie L, et al. Efficacy of combined phacoemulsification and goniosynechialysis in primary angle closure disease with different degrees of peripheral anterior synechiae. J Glaucoma. 2022;31(7):540-546. doi:10.1097/IJG.0000000000002050