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

  • Glaucoma
  • Published:
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Abstract

Aims

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.

Methods

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.

Results

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.

Conclusions

The outcome of phaco-GSL for PAC/PACG may depend on age, preoperative IOP, and postoperative LPI.

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References

  1. Campbell DG, Vela A (1984) Modern goniosynechialysis for the treatment of synechial angle-closure glaucoma. Ophthalmology 91:1052–1060

    PubMed  CAS  Google Scholar 

  2. Shingleton BJ, Chang MA, Bellows AR, Thomas JV (1990) Surgical goniosynechialysis for angle-closure glaucoma. Ophthalmology 97:551–556

    PubMed  CAS  Google Scholar 

  3. Tanihara H, Nishiwaki K, Nagata M (1992) Surgical results and complications of goniosynechialysis. Graefes Arch Clin Exp Ophthalmol 230:309–313

    Article  PubMed  CAS  Google Scholar 

  4. Teekhasaenee C, Ritch R (1999) Combined phacoemulsification and goniosynechialysis for uncontrolled chronic angle-closure glaucoma after acute angle-closure glaucoma. Ophthalmology 106:669–674, discussion 674-675

    Article  PubMed  CAS  Google Scholar 

  5. Harasymowycz PJ, Papamatheakis DG, Ahmed I, Assalian A, Lesk M, Al-Zafiri Y, Kranemann C, Hutnik C (2005) Phacoemulsification and goniosynechialysis in the management of unresponsive primary angle closure. J Glaucoma 14:186–189

    Article  PubMed  Google Scholar 

  6. Lai JS, Tham CC, Lam DS (2001) The efficacy and safety of combined phacoemulsification, intraocular lens implantation, and limited goniosynechialysis, followed by diode laser peripheral iridoplasty, in the treatment of cataract and chronic angle-closure glaucoma. J Glaucoma 10:309–315

    Article  PubMed  CAS  Google Scholar 

  7. The Advanced Glaucoma Intervention Study (AGIS) (2002) 11. Risk factors for failure of trabeculectomy and argon laser trabeculoplasty. Am J Ophthalmol 134:481–498

    Article  Google Scholar 

  8. Tanihara H, Nagata M (1991) Argon-laser gonioplasty following goniosynechialysis. Graefes Arch Clin Exp Ophthalmol 229:505–507

    Article  PubMed  CAS  Google Scholar 

  9. Lai JS, Tham CC, Chua JK, Lam DS (2000) Efficacy and safety of inferior 180 degrees goniosynechialysis followed by diode laser peripheral iridoplasty in the treatment of chronic angle-closure glaucoma. J Glaucoma 9:388–391

    Article  PubMed  CAS  Google Scholar 

  10. Tran HV, Liebmann JM, Ritch R (2003) Iridociliary apposition in plateau iris syndrome persists after cataract extraction. Am J Ophthalmol 135:40–43

    Article  PubMed  Google Scholar 

  11. Nonaka A, Kondo T, Kikuchi M, Yamashiro K, Fujihara M, Iwawaki T, Yamamoto K, Kurimoto Y (2006) Angle widening and alteration of ciliary process configuration after cataract surgery for primary angle closure. Ophthalmology 113:437–441

    Article  PubMed  Google Scholar 

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Acknowledgment

This work was supported in part by Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology (MEXT), Tokyo, Japan, and from the Ministry of Health, Labor and Welfare, Tokyo, Japan.

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Authors and Affiliations

  1. Department of Ophthalmology and Visual Science, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Japan

    Takanori Kameda, Toshihiro Inoue, Masaru Inatani & Hidenobu Tanihara

  2. Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Takanori Kameda

Authors
  1. Takanori Kameda
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  2. Toshihiro Inoue
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  3. Masaru Inatani
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  4. Hidenobu Tanihara
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Consortia

Japanese Phaco-Goniosynechialysis Multicenter Study Group

Corresponding author

Correspondence to Toshihiro Inoue.

Additional information

Members of Japanese Phaco-Goniosynechialysis Multicenter Study Group

Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan: Takanori Kameda, Toshihiro Inoue, Masaru Inatani, and Hidenobu Tanihara. Kyoto University Graduate School of Medicine, Kyoto, Japan: Takanori Kameda, Hideo Nakanishi, and Nagahisa Yoshimura. Nagata Eye Clinic, Nara, Japan: Noriko Toyokawa and Shinichiro Kuroda. Tenri Hospital, Tenri, Japan: Tadamichi Akagi and Hirokazu Nishiwaki. Kobe City Medical Center General Hospital, Kobe, Japan: Kyoko Kumagai and Yasuo Kurimoto.

The authors have full control of all primary data, and they agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data upon request.

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Kameda, T., Inoue, T., Inatani, M. et al. Long-term efficacy of goniosynechialysis combined with phacoemulsification for primary angle closure. Graefes Arch Clin Exp Ophthalmol 251, 825–830 (2013). https://doi.org/10.1007/s00417-012-2091-8

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  • DOI: https://doi.org/10.1007/s00417-012-2091-8

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