Angle Closure Surgery Effective Regardless of Peripheral Anterior Synechiae Degree

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.