Management of Different Subtypes of Primary Angle Closure with Phacoemulsification and Viscogoniosynechialysis

Combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation in the treatment of PACG with cataract

AIM

To investigate the efficacy and safety of combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation (PGE group and PG group) for the treatment of patients with coexisting primary angle-closure glaucoma (PACG) and cataracts.

METHODS

The clinical data of patients with PACG and cataract were retrospectively reviewed. There was a total of 88 eyes in the study and were divided into two groups, 42 eyes in PGE group and 46 eyes in PG group. Surgery success cumulative survival, preoperative and postoperative intraocular pressure (IOP), number of IOP-lowering medications, best corrected visual acuity (BCVA) in the two groups were observed for more than 12mo and compared within each group and between two groups.

RESULTS

The mean IOP in PGE group declined from 24.9 mm Hg preoperatively to 14.1 mm Hg at the first month after operation (P<0.001) and at the last visit 16.2 mm Hg (P<0.001). Meanwhile PG group also showed significant decrease, from 24.1 mm Hg preoperatively to 13.0 mm Hg at 1mo after operation (P<0.001) and 15.3 mm Hg at the last visit (P=0.004). The mean medications reliance reduced in both groups, in PGE group was reduced from 1.62 preoperatively to 0.13 at the last visit (P<0.001), in PG group from 0.87 to 0.10 (P<0.001). At the last visit, BCVA increased from 0.21 to 0.60 in PGE group (P<0.001) and from 0.24 to 0.67 in PG group (P<0.001). The success rate of PGE group at 1mo was 95.2%, then decreased to 70.7% at the last visit, whereas in PG group, the success rate at 1mo was 100%, at the last visit was 73.4%.

CONCLUSION

PGE shows promise for PACG patients with cataracts to reduce IOP, lighten the medication burden and improve visual acuity, and PG still has its value in specific patients.

Factors Associated with Outcomes of Combined Phacoemulsification and Ahmed Glaucoma Valve Implantation

Purpose

To evaluate outcomes and factors associated with surgical failure in patients who underwent combined phacoemulsification and Ahmed glaucoma valve (AGV) implantation.

Methods

This retrospective and longitudinal study enrolled 40 eyes (38 patients) that underwent combined phacoemulsification and AGV implantation. Visual acuity, intraocular pressure (IOP), and number of antiglaucoma medications were evaluated preoperatively and postoperatively. Complete success was defined as a last follow-up IOP of 6 to 21 mmHg without medication, qualified success as an IOP of 6 to 21 mmHg with medication, and failure as an IOP of >21 or <6 mmHg.

Results

The mean follow-up period was 18 ± 10 months. Preoperative diagnoses were chronic angle closure glaucoma (35.0%), neovascular glaucoma (22.5%), uveitic glaucoma (17.5%), primary open-angle glaucoma (15.0%), and other (10.0%). IOP decreased from a mean of 30.5 ± 8.7 to 14.5 ± 3.7 mmHg at the last follow-up visit (p < 0.001). Treatment was classified as qualified success in 18 eyes (45%), complete success in 15 (37.5%), and failure in seven (17.5%). Twenty-two eyes (55%) showed improvement in visual acuity. The most common postoperative complication was a transient hypertensive phase (five eyes, 12.5%). Tube-iris touch was associated with surgical failure (hazard ratio, 8.615; p = 0.008).

Conclusions

Combined phacoemulsification and AGV implantation is an effective and safe surgical option for patients with refractory glaucoma and cataract. Postoperative tube-iris touch is an indicator of poor prognosis.