Five-year reoperation rates following phacoemulsification combined with goniosynechialysis in primary and lens-related angle-closure glaucoma

To compare reoperation rates following phacoemulsification combined with goniosynechialysis (Phaco-GSL) between patients with primary angle-closure glaucoma (PACG) and angle closure secondary to lens subluxation (ASAC-LS) within 5 years, and to identify risk factors for reoperation.

Retrospective, comparative cohort study.

We analyzed patients with PACG and ASAC-LS who underwent Phaco-GSL at Beijing Tongren Hospital between 2016 and 2021. The primary outcome was reoperation rates within 5 years. Kaplan-Meier analysis compared cumulative reoperation rates, and Cox regression identified risk factors for reoperation.

Among 3084 PACG and 745 ASAC-LS eyes, the ASAC-LS group showed a significantly higher 5-year reoperation rate (2.3% vs. 0.9%, P = 0.003). Temporal analysis showed a higher risk for patients with ASAC-LS between 31 and 180 days postoperatively. Reoperation indications differed markedly between groups, with intraocular lens subluxation predominating in the ASAC-LS reoperations (50.0%), while uncontrolled intraocular pressure (IOP) was most common in PACG (56.0%). Independent risk factors for reoperation included: age > 60 years (HR = 5.132, P < 0.001), ASAC-LS diagnosis (HR = 3.619, P = 0.004), previous glaucoma surgery (HR = 4.257, P = 0.002), and higher preoperative IOP (HR = 1.043, P = 0.006).

Patients with ASAC-LS have a higher reoperation risk after Phaco-GSL than those with PACG. Recognizing identified risk factors allows for the optimization of surgical approaches and the development of tailored follow-up protocols for high-risk patients.