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Efficacy and safety of primary customized phacoemulsification combined with goniosynechialysis for refractory acute primary angle closure

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Abstract

Purpose

To assess the safety, efficacy, and long-term clinical outcomes of primary customized phacoemulsification (phaco) combined with goniosynechialysis (GSL; phaco-GSL) in refractory acute primary angle closure (APAC) eyes with uncontrolled high intraocular pressure (IOP).

Methods

This retrospective case series comprised 51 eyes of 42 consecutive patients with refractory APAC and high IOP who were treated using primary customized phaco-GSL at 3 hospitals in China, from 2014 to 2021. Preoperative and postoperative IOP, corrected distant visual acuity (CDVA), corneal endothelial cell density (CECD), intraoperative and postoperative complications were recorded. The safety, efficacy and subsequent long-term clinical outcomes were analyzed.

Results

The mean CDVA (LogMAR) was improved from 1.67 ± 0.94 preoperatively to 0.23 ± 0.26 postoperatively (P < 0.001). Preoperative CECD was 2309.39 ± 541.03 cells/mm2 in 33 eyes and inaccessible in 18 eyes due to severe corneal edema; at the final follow-up, the mean CECD of all patients was 1823.50 ± 533.40 cells/mm2 (P < 0.001). The mean IOP decreased from 48.51 ± 6.25 mmHg preoperatively to 15.66 ± 2.27 mmHg at the final follow-up (P < 0.001). Among 51 eyes, additional customized procedures performed were corneal indentation in 42 eyes, epithelial debridement in 9 eyes, giant epithelial bullae view in 4 eyes, pars-plana fluid aspiration in 3 eyes, and secondary intraocular lens implantation in 7 eyes. The IOP of all eyes was well controlled eventually and 47 eyes (92.16%) were successfully treated by phaco-GSL alone. No significant intraoperative or postoperative complications were observed.

Conclusions

Primary customized phaco-GSL is a safe and effective surgical management strategy for patients with refractory APAC and high IOP.

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Data availability

The data generated during or/and analyzed during the current study are available from the corresponding author.

References

  1. Tham Y-C, Li X, Wong TY, Quigley HA, Aung T, Cheng C-Y (2014) Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 121(11):2081–2090. https://doi.org/10.1016/j.ophtha.2014.05.013

    Article  PubMed  Google Scholar 

  2. Sun X, Dai Y, Chen Y, Yu D-Y, Cringle SJ, Chen J, Kong X, Wang X, Jiang C (2017) Primary angle closure glaucoma: What we know and what we don’t know. Prog Retin Eye Res 57:26–45. https://doi.org/10.1016/j.preteyeres.2016.12.003

    Article  PubMed  Google Scholar 

  3. Chan PP, Pang JC, Tham CC (2019) Acute primary angle closure-treatment strategies, evidences and economical considerations. Eye 33(1):110–119. https://doi.org/10.1038/s41433-018-0278-x

    Article  PubMed  Google Scholar 

  4. Lim MCC, Lim LS, Gazzard G, Husain R, Chan Y-H, Seah SKL, Aung T (2006) Lens opacity, thickness, and position in subjects with acute primary angle closure. J Glaucoma 15(3):260–263

    Article  PubMed  Google Scholar 

  5. Husain R, Gazzard G, Aung T, Chen Y, Padmanabhan V, Oen FTS, Seah SKL, Hoh S-T (2012) Initial management of acute primary angle closure: a randomized trial comparing phacoemulsification with laser peripheral iridotomy. Ophthalmology 119(11):2274–2281. https://doi.org/10.1016/j.ophtha.2012.06.015

    Article  PubMed  Google Scholar 

  6. Varma D, Baylis O, Wride N, Phelan PS, Fraser SG (2007) Viscogonioplasty: an effective procedure for lowering intraocular pressure in primary angle closure glaucoma. Eye 21(4):472–475

    Article  CAS  PubMed  Google Scholar 

  7. Hou X, Hu D, Cui Z, Zhou J, Cai L, Wang Y (2015) Small-incision phacotrabeculectomy versus phacoemulsification in refractory acute primary angle closure with cataract. BMC Ophthalmol 15:88. https://doi.org/10.1186/s12886-015-0074-3

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fakhraie G, Vahedian Z, Moghimi S, Eslami Y, Zarei R, Oskouee JF (2012) Phacoemulsification and goniosynechialysis for the management of refractory acute angle closure. Eur J Ophthalmol 22(5):714–718. https://doi.org/10.5301/ejo.5000101

    Article  PubMed  Google Scholar 

  9. Razeghinejad MR (2008) Combined phacoemulsification and viscogoniosynechialysis in patients with refractory acute angle-closure glaucoma. J Cataract Refract Surg 34(5):827–830. https://doi.org/10.1016/j.jcrs.2008.01.014

    Article  PubMed  Google Scholar 

  10. Zhang Z, Chen M, Yin J, Yao K (2014) Microcoaxial phacoemulsification combined with viscogoniosynechialysis for patients with refractory acute angle-closure glaucoma. J Glaucoma 23(2):119–124. https://doi.org/10.1097/IJG.0b013e318268518d

    Article  CAS  PubMed  Google Scholar 

  11. Römkens HCS, Beckers HJM, Schouten JSAG, Nuijts RMMA, Berendschot TTJM, Breusegem CM, Webers CAB (2018) Early phacoemulsification after acute angle closure in patients with coexisting cataract. J Glaucoma 27(8):711–716. https://doi.org/10.1097/IJG.0000000000000998

    Article  PubMed  Google Scholar 

  12. Lai JSM, Tham CCY, Chan JCH (2006) The clinical outcomes of cataract extraction by phacoemulsification in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract: a prospective case series. J Glaucoma 15(1):47–52

    Article  PubMed  Google Scholar 

  13. Noh HJ, Kim ST (2019) Combined treatment of phacoemulsification and single-port limited pars plana vitrectomy in acute angle-closure glaucoma. Int J Ophthalmol 12(6):974–979. https://doi.org/10.18240/ijo.2019.06.15

    Article  PubMed  PubMed Central  Google Scholar 

  14. Li S, Tang G, Fan SJ, Zhai G, Lv J, Zhang H, Lu W, Jiang J, Lv A, Wang N et al (2021) Factors associated with blindness three months following treatment for acute primary angle glaucoma. Br J Ophthalmol 105(4):502–506. https://doi.org/10.1136/bjophthalmol-2020-316259

    Article  PubMed  Google Scholar 

  15. Lee JWY, Lai JSM, Yick DWF, Yuen CYF (2012) Prospective study on retinal nerve fibre layer changes after an acute episode of phacomorphic angle closure. Int Ophthalmol 32(6):577–582. https://doi.org/10.1007/s10792-012-9614-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Schulze-Bonsel K, Feltgen N, Burau H, Hansen L, Bach M (2006) Visual acuities “hand motion” and “counting fingers” can be quantified with the freiburg visual acuity test. Invest Ophthalmol Vis Sci 47(3):1236–1240

    Article  PubMed  Google Scholar 

  17. Anderson DR (1979) Corneal indentation to relieve acute angle-closure glaucoma. Am J Ophthalmol 88(6):1091–1093

    Article  CAS  PubMed  Google Scholar 

  18. Masselos K, Bank A, Francis IC, Stapleton F (2009) Corneal indentation in the early management of acute angle closure. Ophthalmology 116(1):25–29. https://doi.org/10.1016/j.ophtha.2008.08.032

    Article  PubMed  Google Scholar 

  19. Matsunaga K, Ito K, Esaki K, Sugimoto K, Sano T, Miura K, Sasoh M, Uji Y (2004) Evaluation and comparison of indentation ultrasound biomicroscopy gonioscopy in relative pupillary block, peripheral anterior synechia, and plateau iris configuration. J Glaucoma 13(6):516–519

    Article  PubMed  Google Scholar 

  20. Amini R, Barocas VH (2009) Anterior chamber angle opening during corneoscleral indentation: the mechanism of whole eye globe deformation and the importance of the limbus. Investig Ophthalmol Vis Sci 50(11):5288–5294. https://doi.org/10.1167/iovs.08-2890

    Article  Google Scholar 

  21. Daglioglu MC, Coskun M, Ilhan N, Tuzcu EA, Ilhan O, Keskin U, Ayintap E, Oksuz H (2014) The effects of soft contact lens use on cornea and patient’s recovery after autograft pterygium surgery. Cont Lens Anterior Eye 37(3):175–177. https://doi.org/10.1016/j.clae.2013.09.012

    Article  PubMed  Google Scholar 

  22. Higashide T, Sugiyama K (2008) Use of viscoelastic substance in ophthalmic surgery—focus on sodium hyaluronate. Clin Ophthalmol 2(1):21–30

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Nossair AA, Ewais WA, Ali LS (2017) Retrospective study of vitreous tap technique using needle aspiration for management of shallow anterior chamber during phacoemulsification. J Ophthalmol 2017:2801025. https://doi.org/10.1155/2017/2801025

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kuriakose T, Jasper S, Thomas S (2018) Pars-plana fluid aspiration for positive vitreous cavity pressure in anterior segment surgeries. Indian J Ophthalmol 66(4):565–567. https://doi.org/10.4103/ijo.IJO_939_17

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sethi H, Dada T (2002) Pars plana vitreous tap in crowded eyes. J Cataract Refract Surg 28(11):1897

    Article  PubMed  Google Scholar 

  26. Bigar F, Witmer R (1982) Corneal endothelial changes in primary acute angle-closure glaucoma. Ophthalmology 89(6):596–599

    Article  CAS  PubMed  Google Scholar 

  27. Mortensen AC, Sperling S (1982) Human corneal endothelial cell density after an in vitro imitation of elevated intraocular pressure. Acta Ophthalmol 60(3):475–479

    Article  CAS  Google Scholar 

  28. Park H-YL, Lee NY, Park CK, Kim MS (2012) Long-term changes in endothelial cell counts after early phacoemulsification versus laser peripheral iridotomy using sequential argon:YAG laser technique in acute primary angle closure. Graefe’s Archive Clin Exp Ophthalmol 250(11):1673–1680. https://doi.org/10.1007/s00417-012-1998-4

    Article  Google Scholar 

  29. Ko YC, Liu CJL, Lau LI, Wu CW, Chou JC, Hsu WM (2008) Factors related to corneal endothelial damage after phacoemulsification in eyes with occludable angles. J Cataract Refract Surg 34(1):46–51. https://doi.org/10.1016/j.jcrs.2007.07.057

    Article  PubMed  Google Scholar 

  30. Hamanaka T, Kasahara K, Takemura T (2011) Histopathology of the trabecular meshwork and Schlemm’s canal in primary angle-closure glaucoma. Investig Ophthalmol Vis Sci 52(12):8849–8861. https://doi.org/10.1167/iovs.11-7591

    Article  Google Scholar 

  31. Kaplowitz K, Yung E, Flynn R, Tsai JC (2015) Current concepts in the treatment of vitreous block, also known as aqueous misdirection. Survey Ophthalmol 60(3):229–241. https://doi.org/10.1016/j.survophthal.2014.12.004

    Article  Google Scholar 

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Acknowledgements

None.

Funding

Publication of this article was supported by the Natural Science Foundation of Fujian Province (2022J011006).

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Authors and Affiliations

  1. Department of Ophthalmology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China

    Xinna Wu, Xiaobao Liu, Suzhen Xiao, Yajing Cai, Mengting Yu & Wenjie Wu

  2. Department of Ophthalmology, Zhangzhou Municipal Hospital of Fujian Province, Zhangzhou, China

    Xinna Wu

  3. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong, China

    Mengting Yu

  4. Department of Ophthalmology, Guangze County Hospital, Nanping, China

    Binqiang Xu

  5. Department of Ophthalmology, Funing County Hospital, Ningde, China

    Yanling Wang

  6. Department of Ophthalmology, Fujian Provincial Hospital, 134.Dongjie Rd, Fuzhou, 350001, Fujian Province, China

    Wenjie Wu

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  1. Xinna Wu
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  3. Suzhen Xiao
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  8. Wenjie Wu
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Contributions

XW was responsible for designing the review protocol, writing the protocol, conducting the search, screening potentially eligible studies, extracting and analyzing data, and interpreting results. XL was responsible for designing the review protocol, screening potentially eligible studies, and analyzing data. SX, YC, MY, BX and YW contributed to conducting the search, data extraction, updating reference lists and provided feedback on the report. WW contributed to writing the report, extracting and analyzing data, and interpreting results.

Corresponding author

Correspondence to Wenjie Wu.

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The authors declare no conflict of interest.

Ethics approval

This study has been evaluated by the institutional review board of Fujian Provincial Hospital and deemed not required ethics approval.

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Patients provided written informed consent prior to undergoing any study procedure.

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Written informed consent included consent for publication of aggregated study results.

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Cite this article

Wu, X., Liu, X., Xiao, S. et al. Efficacy and safety of primary customized phacoemulsification combined with goniosynechialysis for refractory acute primary angle closure. Int Ophthalmol 43, 4515–4525 (2023). https://doi.org/10.1007/s10792-023-02852-6

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  • DOI: https://doi.org/10.1007/s10792-023-02852-6

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