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Aqueous outflow facility after phacoemulsification with or without goniosynechialysis in primary angle closure: a
Ian A Rodrigues1, Pouya Alaghband1, Laura Beltran Agullo1
1Department of Ophthalmology, St Thomas' Hospital, London, UK.
The British Journal of Ophthalmology
|April 13, 2017
Summary
Goniosynechialysis (GSL) combined with cataract surgery significantly improved aqueous outflow and reduced intraocular pressure and medication needs in primary angle closure glaucoma patients. This combined approach offers functional benefits beyond standard cataract surgery alone.
Area of Science:
- Ophthalmology
- Glaucoma Research
- Surgical Innovation
Background:
- Goniosynechialysis (GSL) theoretically aids in removing peripheral anterior synechiae (PAS) during cataract surgery.
- Previous randomized trials lacked conclusive evidence on functional benefits and aqueous outflow changes post-GSL.
- The impact of GSL on aqueous outflow facility (TOF) in primary angle closure (PAC) and PAC glaucoma remains largely unknown.
Purpose of the Study:
- To compare the electronic Shiøtz tonographic aqueous outflow facility (TOF) after phacoemulsification with or without GSL.
- To evaluate changes in intraocular pressure (IOP) and glaucoma medication use as secondary outcomes.
- To assess the efficacy of combining GSL with phacoemulsification in PAC and PAC glaucoma patients.
Main Methods:
- A prospective randomized pilot study involving 26 patients on glaucoma medication with significant PAS and lens opacity.
- Patients were randomized to either phacoemulsification with intraocular lens (IOL) implantation (phaco) or phacoemulsification with IOL plus GSL (phaco-GSL).
- TOF, IOP, medication use, and PAS extent were measured at baseline and 6 months postoperatively.
Main Results:
- The phaco-GSL group showed a significant increase in TOF (0.099 to 0.194 μL/min/mmHg, p=0.0006), unlike the phaco-alone group.
- Intraocular pressure (IOP) reduction was significantly greater in the phaco-GSL group (46.0%) compared to the phaco-alone group (27.6%, p=0.04).
- Phaco-GSL also led to significant reductions in glaucoma medication use and PAS extent, with no serious adverse events reported.
Conclusions:
- Combining GSL with standard phacoemulsification significantly increased TOF in PAC and PAC glaucoma patients.
- This combined surgical approach resulted in reduced IOP, medication dependence, and PAS.
- Goniosynechialysis should be considered as an adjunct to phacoemulsification in select patients with primary angle closure.