Phacoemulsification and goniosynechialysis for the management of refractory acute angle closure

Abstract

To evaluate the effectiveness of phacoemulsification with goniosynechialysis in the management of refractory acute angle closure (AAC). In this prospective, noncomparative interventional case series, patients with AAC who were unresponsive to medical and laser therapy were included. Success was defined as complete if intraocular pressure (IOP) had a drop of at least 30% and was between 6 and 21 mmHg without medication, and qualified if IOP was within that range with medication. A total of 24 patients with a mean age of 56 years (range 39-77) were treated. Mean follow-up time was 15.7 ± 4.2 months (range 6-24). Mean preoperative and last visit IOPs were 34.27 ± 7.23 mmHg and 17.5 ± 3.21 mmHg, respectively (p<0.001). Mean number of glaucoma medication dropped from 3.67 ± 0.48 to 0.63 ± 1.05 (p<0.001). There was a positive correlation between the attack-surgery interval and last visit IOP (p<0.001, r=0.697). There was a negative correlation between the preoperative anterior chamber depth and last visit IOP drop (p=0.03, r=-0.56). Also, a positive correlation was found between the preoperative IOP and last visit IOP drop (p<0.001, r=0.896). At final visit, complete and qualified success was achieved in 17/24 (71%) and 5/24 (21%) cases, respectively. The most common intraoperative and postoperative complications were hyphema and anterior chamber fibrinous reaction, respectively. Phacoemulsification with goniosynechialysis seems to be a safe and effective method for the management of patients with refractory AAC. This procedure can be considered for these patients before proceeding with filtering surgery.