Surgical Efficacy After Viscogonioplasty in Primary Angle Closure Disease With Different Mechanisms

Nonpupillary block mechanisms are associated with larger postoperative peripheral anterior synechiae (PAS) extent at 1-year follow-up compared with pupillary block mechanisms in primary angle-closure disease (PACD).

To evaluate the impact of preoperative angle closure mechanisms on the surgical outcomes of phacoemulsification and intraocular lens implantation (PEI) combined with VGP in PACD patients with cataracts.

This prospective cohort study enrolled 56 patients (68 eyes) with PACD and cataracts. Participants were classified into pupillary block (PB) and nonpupillary block (Non-PB) groups based on the anatomic characteristics of angle closure shown in preoperative ultrasound biomicroscopy imaging. Primary outcomes included peripheral anterior synechiae (PAS) extent, intraocular pressure (IOP), and number of IOP-lowering medications over a 12-month follow-up period.

Both groups showed significant reductions in PAS extent at the end of surgery compared with the baseline. At 6 and 12 months postoperatively, the Non-PB group exhibited significantly larger PAS extent compared with the PB group ( P =0.025 and 0.017, respectively). Both groups demonstrated significant IOP reduction and decreased use of IOP-lowering medications postoperatively, with no significant differences between groups. The overall complete and qualified success rates at 12 months were 71.6% and 98.5%, respectively, with no significant difference between groups.

Non-PB mechanisms are associated with larger postoperative PAS extent at 1-year follow-up compared with PB mechanisms, emphasizing the importance of comprehensive preoperative angle closure mechanisms assessment in predicting and potentially minimizing PAS progression for enhanced long-term surgical efficacy in PACD treatment.