1. Combined Phacoemulsification With Goniosynechialysis Under Ophthalmic Endoscope for Primary Angle-closure Glaucoma After Failed Trabeculectomy.
- Author
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Nie L, Fu L, Chan YK, Fang A, and Pan W
- Subjects
- Adult, Aged, Cataract complications, Endoscopes, Female, Glaucoma, Angle-Closure physiopathology, Gonioscopy, Humans, Intraocular Pressure physiology, Male, Middle Aged, Retrospective Studies, Tonometry, Ocular, Treatment Failure, Visual Acuity physiology, Endoscopy, Glaucoma, Angle-Closure surgery, Iris Diseases surgery, Phacoemulsification, Tissue Adhesions surgery, Trabeculectomy
- Abstract
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.
- Published
- 2020
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