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Phaco plus goniosynechialysis adds no IOP-lowering benefit in angle closure
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No additional benefit in IOP-lowering effect was seen when goniosynechialysis was added to phacoemulsification in patients with primary angle closure glaucoma and cataract.
In four Asian cohorts from Singapore, Hong Kong, Vietnam and Thailand, 78 patients were randomly assigned to undergo phacoemulsification alone or phacoemulsification with goniosynechialysis. At baseline, mean IOP was 22.3 mm Hg in the phaco-alone group and 22.9 mm Hg in the combined group, and demographic and ocular characteristics between the groups were similar.
At 1 year postoperatively, mean IOP was 14.3 mm Hg in the phaco group and 15.9 mm Hg in the combined group, with no statistically significant difference between the two.
Twenty-one patients in the phaco-alone group achieved successful control of IOP, defined as IOP of 21 mm Hg or less without topical IOP-lowering medications and a decrease in IOP of 20% or more from baseline. Twenty-two patients in the combined group achieved complete success, again demonstrating no statistically significant difference between the two groups. Mean IOP at 1 year in these patients was 12.5 mm Hg in the phaco-alone group and 13.6 mm Hg in the combined group.
Qualified success, defined as IOP of 21 mm Hg or less with use of topical IOP-lowering medications and a decrease in IOP of 20% or more from baseline, was achieved in 95% of patients in the phaco-alone group and in 92.1% of the combined group.
In both groups, reduction of peripheral anterior synechiae (PAS) was nearly equal at 1 year, implying that PAS “must have reformed” after its removal in the combined procedure and that phaco alone “was sufficient enough to break more than half of the PAS present at baseline — an unexpected finding,” the authors wrote.
Disclosures: The authors report no relevant financial disclosures.
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