Combined phacoemulsification and viscogoniosynechialysis in the management of patients with chronic angle closure glaucoma

Abstract

The purpose of this study was to evaluate the effectiveness of phacoemulsification and viscogoniosynechialysis in the management of patients with chronic angle-closure glaucoma (CACG). Fifty-six eyes of 45 recruited patients were classified into two groups: group 1 had medically controlled CACG (IOP ≤ 21 mmHg) comprising 35 eyes and group 2 medically uncontrolled CACG (IOP > 21 mmHg with maximum tolerated medications) including 21 eyes. All of the patients had at least one quadrant without peripheral anterior synechia in gonioscopy. After phacoemulsification, a viscoelastic agent was used for viscogoniasynecialysis. Success was defined as IOP ≤ 21 mmHg with (relative success) or without (absolute success) medications. There were no statistically significant differences between the two groups regarding age and gender. In group 1, the mean IOP and number of medications declined from 16.7 ± 2.9 to 14.4 ± 2.9 (P < 0.0001) and 2.6 ± 0.8 to 0.82 ± 0.82 (P < 0.0001), respectively. The absolute success rate at the last follow-up (9 ± 5.3 months) was 40%. In group 2, the mean IOP and number of medications diminished from 27.95 ± 8.1 to 15.5 ± 2.8 (P < 0.0001) and 2.9 ± 0.62 to 1.2 ± 1.2 (P < 0.0001), respectively. The absolute success rate was 38.1% at the last follow-up (9.5 ± 5.3 months). Postoperatively, seven patients developed pupillary fibrin formation that was treated using steroids and ND:YAG laser. In the other two patients, the medically unresponsive cystoid macular edema was treated successfully by intravitreal Bevacizumab. Combined phacoemulsification and viscogoniosynechialysis seem to be an effective surgical procedure in the treatment of patients with CACG and angle restoration whether controlled or uncontrolled by medication.