Long-term efficacy of goniosynechialysis combined with phacoemulsification for primary angle closure

Abstract

To evaluate long-term efficacy of goniosynechialysis (GSL) combined with phacoemulsification and intraocular lens implantation (phaco-GSL) for primary angle closure or primary angle-closure glaucoma (PAC/PACG) and to analyze risk factors for surgical outcomes. We reviewed medical records of 109 eyes of 109 patients (mean [± SD] age 70 ± 9.4 years) who underwent phaco-GSL as primary treatment of PAC/PACG at five institutions. All eyes had a preoperative intraocular pressure (IOP) of ≥ 21 mmHg with or without medications. Surgical failure was defined as: (1) condition A: persistent IOP values of ≥ 21 mmHg, or (2) condition B: IOP values of ≥ 18 mmHg, with or without topical ocular medication, at two consecutive follow-up visits, or additional operations needed. Risk factors for surgical failure were analyzed via Cox proportional hazards model. Mean follow-up was 40.0 months (range, 1 to 139 months). Probabilities of treatment success at 1 and 3 years after phaco-GSL were 85.9 % and 85.9 % (condition A) and 66.2 % and 61.0 % (condition B) respectively. Via multivariable analysis, we identified risk factors for surgical failure to be younger age (relative risk [RR] = 0.93/year, P = 0.0333) and absence of postoperative laser peripheral iridoplasty (LPI) (P = 0.0359) for condition A, and younger age (RR = 0.94/year, P = 0.0035), lower preoperative IOP (RR = 0.93/mm Hg, P = 0.0131), and absence of postoperative LPI (RR = 2.34, P = 0.0228) for condition B. The outcome of phaco-GSL for PAC/PACG may depend on age, preoperative IOP, and postoperative LPI.