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Abstract #90518 Published in IGR 21-3
Combined Phacoemulsification With Goniosynechialysis Under Ophthalmic Endoscope for Primary Angle-closure Glaucoma After Failed Trabeculectomy
Nie L; Fu L; Chan YK; Fang A; Pan WJournal of Glaucoma 2020; 29: 941-947
PRECIS: Phacoemulsification with goniosynechialysis under an ophthalmic endoscope (Phaco-OE-GSL) is safe and able to lowering intraocular pressure (IOP) for failed trabeculectomy in primary angle-closure glaucoma with cataract. The larger pupil diameter and younger age are identified as the 2 risk factors for surgical outcome. PURPOSE: To investigate the efficacy and safety of combined Phaco-OE-GSL for primary angle-closure glaucoma with cataract after failed trabeculectomy. MATERIALS AND METHODS: Twenty-five patients (25 eyes) were enrolled in this retrospective study. IOP, best-corrected visual acuity, and number of glaucoma medications at baseline and each postoperative follow-up visit were recorded. Peripheral anterior synechia (PAS) was recorded using gonioscopy. Binary logistic regression was used to analyze the risk factors of surgical failure. RESULTS: The mean follow-up duration was 17.9±11.4 months. The mean IOP was significantly lower than the preoperative baseline IOP at all time points (P<0.001). The mean IOP was reduced from 24.4±6.5 mm Hg at baseline to 14.2±3.0 mm Hg at the last follow-up. The mean preoperative number of glaucoma medications was 2.2±1.2, which reduced to 0.9±1.1 at the last follow-up. The complete success rates at 1 year and the last follow-up were 70.6% and 68%, respectively. The total success rates were 96% and 92%, respectively. The most common postoperative complications were IOP spikes (48%) and hyphemas (32%). All eyes had degrees of PAS recurrence, with a range of 96.1±52.5 degrees (30 to 210 degrees) after 4 to 6 months. Larger pupil diameter and younger age were significantly associated with the failure of Phaco-OE-GSL. CONCLUSIONS: Phaco-OE-GSL is safe and can lower IOP for failed trabeculectomy in PACG with cataract despite the high recurrence rate of PAS.
Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang Province.
Full articleClassification:
12.14.3 Phacoemulsification (Part of: 12 Surgical treatment > 12.14 Combined cataract extraction and glaucoma surgery)
12.9 Trabeculotomy, goniotomy (Part of: 12 Surgical treatment)