Phacoemulsification and viscogoniosynechialysis for primary angle closure glaucoma

Objective To investigate the clinical effects and indications of phacoemulsification and soft intraocular lens(IOL)implantation combined with viscogoniosynechialysis in the management of primary angle closure glaucoma(PACG).Methods Forty-six eyes of primary angle closure glaucoma with co-existing cataract were treated with phacoemulsification and IOL implantation combined with goniosynechialysis.The mean follow-up duration was 9 to 24 months.The main outcome measures were pre-operative and post-operative changes of intraocular pressure,visual acuity,depth of anterior chamber,anterior chamber angle,outflow facility of aqueous humor(C values)and PO/C ratio,and the number of glaucoma eye drops required.Results Compared with pre-operation,intraocular pressure was decreased(paired t test,P0.001),visual acuity was improved(P0.01),depth of anterior chamber was deepened(paired t test,P0.001)and anterior chamber angle of 36 eyes(78.26%)was open,outflow facility of aqueous humor(C values)and PO/C ratio were improved(paired t test,P0.01),and the number of glaucoma eye drops required was decreased(paired t test,P0.01).Seven eyes(15.21%)had to undergo trabeculectomy because intraocular pressure was over 25 mmHg after phacoemulsification.Conclusion Phacoemulsification combined with viscogoniosynechialysis is an effective and safe surgical procedure in managing primary angle-closure glaucoma with co-existing cataract.However,trabeculectomy may be necessary for the cases with peripheral anterior synechia more than 270 degrees.