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Purpose: This study aims to evaluate the accuracy of intraocular lens (IOL) power calculation formulas—including Kane, Emmetropia Verifying Optical (EVO) 2.0, SRK/T, Hoffer Q, Haigis standard, Haigis optimized, Holladay 1, Olsen, Barrett Universal II—in primary angle-closure glaucoma (PACG) eyes undergoing cataract surgery combined with goniosynechialysis (GSL). Methods: Preoperative biometric data were obtained using the OA-2000. The preoperative anterior chamber depth (ACD) was categorized into two subgroups: < 2.50 mm and 2.50 to 3.50 mm. The predictive accuracy of the formulas was assessed using the mean prediction error (PE), mean absolute error (MAE), median absolute error (MedAE), and proportions of eyes within ± 0.25D, ± 0.50D, ± 0.75D, and ± 1.00D. Differences in absolute error among the various formulas were examined utilizing the Friedman test. In the case of a significant result, post hoc analysis was conducted employing the Wilcoxon test with Bonferroni correction. Results: A total of 141 eyes of 141 PACG patients were included in the analysis. The standard deviations of the PE, ranked from lowest to highest, were as follows: Holladay 1 (0.67), Kane (0.69), EVO 2.0 (0.71), SRK/T (0.71), Hoffer Q (0.72), Haigis standard (0.74), Haigis optimized (0.76), Olsen (0.77), Barrett Universal II (0.79). Statistically significant differences in absolute refractive errors among the formulas were observed (P = 0.001). Kane formula demonstrated the lowest MedAE (0.34), and the highest percentages of eyes within ± 0.25D (35.46%) and ± 1.00D (89.36%), while EVO 2.0 had the highest percentages within ± 0.50D (65.25%). In the ACD < 2.50 mm subgroup, MedAE differed significantly among formulas (P = 0.001). The Holladay 1 formula had the lowest MedAE (0.33), followed by Kane (0.34), EVO 2.0 (0.37). In the 2.50 ≤ ACD < 3.50 mm subgroup, refractive errors showed no statistically significant differences. Additionally, the percentages within ± 0.25D, ± 0.50D, ± 0.75D, and ± 1.00D demonstrated no significant differences in both subgroups (all P > 0.05). Conclusion: Among the nine formulas, Kane, Holladay 1, and EVO 2.0 demonstrated superior refractive outcomes in PACG eyes. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of phacoemulsification with goniosynechialysis (GSL) versus viscogonioplasty (VGP) on intraocular pressure (IOP) reduction and medication use in angle-closure patients. Materials and Methods: This randomized controlled trial at Sisaket Hospital, Thailand, from November 2021 to May 2024, enrolled patients with angle-closure and cataracts. Group 1 underwent phacoemulsification with GSL, and Group 2 with VGP. Visual acuity, IOP, and medication use were assessed before surgery, then at 1 week, 1 month, 3 months, and 6 months post-surgery. Results: 58 eyes were included: 30 in Group 1 and 28 in Group 2. The average age was 67.16±9.65 years in Group 1 and 67.78±7.38 years in Group 2 (P=0.79). Baseline IOP was 24.31±12.34 mmHg in Group 1 and 24.92±12.50 mmHg in Group 2 (P=0.85). After 6 months, IOP decreased to 12.84±2.88 mmHg in Group 1 and 13.62±4.28 mmHg in Group 2 (P=0.40). Glaucoma medications decreased from 3.47±0.94 to 1.93±1.20 in Group 1 and from 3.54±0.58 to 1.46±1.37 in Group 2 (P=0.17). Hazard ratio: 4.29 (P=0.066, 95% CI: 0.91-20.18). Conclusion: Both Phaco-GSL and Phaco-VGP significantly reduce IOP, with no significant difference in efficacy. Phaco-GSL may sustain IOP reduction longer in extensive PAS cases. However, the short follow-up period and lack of postoperative gonioscopy are limitations. Longer-term studies with larger sample sizes are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of phacoemulsification with goniosynechialysis (GSL) versus viscogonioplasty (VGP) on intraocular pressure (IOP) reduction and medication use in angle-closure patients. Materials and Methods: This randomized controlled trial at Sisaket Hospital, Thailand, from November 2021 to May 2024, enrolled patients with angle-closure and cataracts. Group 1 underwent phacoemulsification with GSL, and Group 2 with VGP. Visual acuity, IOP, and medication use were assessed before surgery, then at 1 week, 1 month, 3 months, and 6 months post-surgery. Results: 58 eyes were included: 30 in Group 1 and 28 in Group 2. The average age was 67.16±9.65 years in Group 1 and 67.78±7.38 years in Group 2 (P=0.79). Baseline IOP was 24.31±12.34 mmHg in Group 1 and 24.92±12.50 mmHg in Group 2 (P=0.85). After 6 months, IOP decreased to 12.84±2.88 mmHg in Group 1 and 13.62±4.28 mmHg in Group 2 (P=0.40). Glaucoma medications decreased from 3.47±0.94 to 1.93±1.20 in Group 1 and from 3.54±0.58 to 1.46±1.37 in Group 2 (P=0.17). Hazard ratio: 4.29 (P=0.066, 95% CI: 0.91–20.18). Conclusion: Both Phaco-GSL and Phaco-VGP significantly reduce IOP, with no significant difference in efficacy. Phaco-GSL may sustain IOP reduction longer in extensive PAS cases. However, the short follow-up period and lack of postoperative gonioscopy are limitations. Longer-term studies with larger sample sizes are needed to confirm these results.

AIM: To evaluate the efficacy of phacoemulsification with intraocular lens implantation(PEI)combined with goniosynechialysis(GSL)and goniotomy(GT)under direct vision with gonioscope in the treatment of advanced primary angle-closure glaucoma(PACG)combined with cataract.METHODS: Retrospective case series study. A total of 62 patients(65 eyes)with advanced PACG combined with cataract who were treated in the Second Hospital of Anhui Medical University from December 1, 2021 to March 31, 2023 were enrolled, and they were divided into two groups according to different surgical methods. The control group(32 cases, 33 eyes)received PEI+GSL, whereas the observation group(30 cases, 32 eyes)received PEI+GSL+GT. The intraocular pressure(IOP), best corrected visual acuity(BCVA)and the number of anti-glaucoma medications of the two groups before surgery and at 1 d, 1 wk, 1, 3, and 6 mo after surgery were evaluated. In addition, the visual field, cup-to-disc ratio(C/D), angle open range, anterior chamber depth, and average thickness of retinal nerve fiber layer(RNFL)were evaluated before and 6 mo after surgery.RESULTS: There were significant differences in IOP and lowering range of average IOP at 6 mo between the PEI+GSL+GT group(16.68±2.65, 11.12±8.53 mmHg)and the PEI+GSL group(18.71±2.51, 8.32±4.17 mmHg; P0.05). The number of anti-glaucoma medications, BCVA, anterior chamber depth, and angle closure range were improved in the two groups at 6 mo after operation(all P0.05). There was no difference in the mean deviation of visual field, C/D and average thickness of RNFL between the two groups at 6 mo after operation compared with those before operation(all P>0.05). The complete surgery success rate of the PEI+GSL+GT group was 81%(26/32), and the conditional success rate was 94%(30/32); while those rates of the PEI+GSL group were 58%(19/33)and 76%(25/33), respectively. There were statistical significance in the success rate of surgery between the two groups(complete success rate χ2=4.275, P=0.039; conditional success rate χ2=4.040, P=0.044). No vision-threatening complications and another surgery occurred in either group.CONCLUSION: The study showed that for patients with advanced PACG with cataract, PEI+GSL+GT is more effective than PEI+GSL.

Abstract Introduction Goniosynechialysis (Phaco-GSL) is a logical therapeutic approach for patients with primary angle-closure glaucoma (PACG) and cataract. The aim of this study was to compare the long-term effectiveness and safety of Phaco-GSL and trabeculectomy (TRB) in the management of PACG with coexisting cataract. Methods A review was conducted on 96 Chinese patients (96 eyes) with PACG and cataract from Peking Union Medical College Hospital (PUMCH). Among them, 56 patients underwent Phaco-GSL, while 40 underwent TRB. Intraocular pressure (IOP), best corrected visual acuity (BCVA), use of supplemental antiglaucoma medical therapy, surgery success rates, and complications for both procedures were assessed. Results The average follow-up period was 50.3 ± 18.7 months in the Phaco-GSL group and 61.2 ± 15.1 months in the TRB group. At the final follow-up, IOP decreased from 27.0 ± 11.1 mmHg to 13.5 ± 2.1 mmHg in the Phaco-GSL group and in the TRB group IOP decreased from 27.1 ± 7.7 mmHg to 16.5 ± 5.5 mmHg. The long-term postoperative IOP in the Phaco-GSL group was significantly lower than that in the TRB group. There was a statistically significant reduction in medication usage in both groups, with the TRB group having a higher number of postoperative medications at the final follow-up. The incidence of postoperative complications was significantly higher in the TRB group compared to the Phaco-GSL group. Conclusions Phaco-GSL is the recommended surgical approach for Chinese patients with primary angle-closure glaucoma (PACG) and cataract. Compared to traditional TRB, eyes undergoing Phaco-GSL show a reduced requirement for antiglaucomatous medications, improved management of IOP, decreased risk of complications, and higher long-term cumulative probability of treatment success for patients with PACG.

Introduction: Goniosynechialysis (Phaco-GSL) is a logical therapeutic approach for patients with primary angle-closure glaucoma (PACG) and cataract. The aim of this study was to compare the long-term effectiveness and safety of Phaco-GSL and trabeculectomy (TRB) in the management of PACG with coexisting cataract. Methods: A review was conducted on 96 Chinese patients (96 eyes) with PACG and cataract from Peking Union Medical College Hospital (PUMCH). Among them, 56 patients underwent Phaco-GSL, while 40 underwent TRB. Intraocular pressure (IOP), best corrected visual acuity (BCVA), use of supplemental antiglaucoma medical therapy, surgery success rates, and complications for both procedures were assessed. Results: The average follow-up period was 50.3 ± 18.7 months in the Phaco-GSL group and 61.2 ± 15.1 months in the TRB group. At the final follow-up, IOP decreased from 27.0 ± 11.1 mmHg to 13.5 ± 2.1 mmHg in the Phaco-GSL group and in the TRB group IOP decreased from 27.1 ± 7.7 mmHg to 16.5 ± 5.5 mmHg. The long-term postoperative IOP in the Phaco-GSL group was significantly lower than that in the TRB group. There was a statistically significant reduction in medication usage in both groups, with the TRB group having a higher number of postoperative medications at the final follow-up. The incidence of postoperative complications was significantly higher in the TRB group compared to the Phaco-GSL group. Conclusions: Phaco-GSL is the recommended surgical approach for Chinese patients with primary angle-closure glaucoma (PACG) and cataract. Compared to traditional TRB, eyes undergoing Phaco-GSL show a reduced requirement for antiglaucomatous medications, improved management of IOP, decreased risk of complications, and higher long-term cumulative probability of treatment success for patients with PACG. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of combined phacoemulsification and goniosynechialysis (PE-GSL) of angle closure glaucoma in patients with uncontrolled intraocular pressure (IOP) and persistent peripheral anterior synechiae (PAS) initially presented with acute angle closure attack. Materials and Methods: The present study was a retrospective cohort study of medical records of Thai glaucoma patients comprising 19 eyes of 19 patients (13 females and 6 males) with acute angle closure attacks. All patients were performed with PE-GSL. Results: There were statistically significant differences between preoperative and postoperative IOP, PAS, and the number of medications required for IOP control. Postoperative visual acuities were improved. At the final examination for each patient, IOP was 12.15±1.57 mmHg (range 10 to 16). The extent of recurrent PAS was 66.32±40.72° (range 0 to 90), and the number of antiglaucoma medications was 0 (range 0 to 2). IOP was less than 20 mmHg in 16 eyes (80%) without medications. Three eyes were controlled with medications. In the 16 eyes with successful PE-GSL, the mean time between the angle closure attack and surgery was 7.5±5.6 weeks. Conclusion: PE-GSL are effective in decreasing IOP, PAS, and medications, as well as improvement of visual acuity in eyes with uncontrolled IOP and persistent PAS in patients who initially presented with acute angle closure attacks. [ABSTRACT FROM AUTHOR]

AIM: To investigate the clinical efficacy of femtosecond laser-assisted phacoemulsification combined with goniosynechialysis in the treatment of acute angle-closure glaucoma complicated with cataract.METHODS: A total of 53 patients(60 eyes)with primary acute angle closure glaucoma complicated with cataract admitted to our hospital from April 2020 to February 2021 were selected. They were divided into two groups according to the surgical method, with 28 cases(30 eyes)who were treated with femtosecond laser-assisted phacoemulsification combined with goniosynechialysis in group A, and 25 cases(30 eyes)who were treated with traditional cataract phacoemulsification combined with goniosynechialysis in group B. The effective phacoemulsification time(EPT)and cumulative dissipated energy(CDE)during surgery in two groups were recorded. Patients were followed up to 3mo after surgery, and the intraocular pressure, anterior chamber depth(ACD), best corrected visual acuity, corneal endothelial cell loss rate(ECL)and surgical complications were observed in both groups.RESULTS: The postoperative intraocular pressure was significantly decreased and ACD was significantly increased(all P0.05). The postoperative best corrected visual acuity of the two groups was significantly better than that before surgery(P

Abstract Purpose To compare the effects of phacoemulsification with intraocular lens implantation (phaco) combined with goniosynechialysis (phaco + GSL) versus phaco with trabeculectomy (phaco + trab) for the management of primary angle-closure glaucoma (PACG) refractory to peripheral anterior synechiae (PAS) of over 180°. Methods This retrospective study followed 77 eyes of 77 patients for at least 6 months. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of glaucoma drugs, and PAS were recorded at the preoperative baseline and evaluated at each postoperative follow-up visit. The National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) was administered to patients enrolled in this study. Pearson’s correlation analysis and multivariate linear analysis were performed to identify factors influencing changes in NEI VFQ-25 scores and to identify factors associated with increases in NEI VFQ-25 scores after the operation. Results In total, seventy-seven eyes were included (43 with phaco + GSL and 34 with phaco + trab). Comparing preoperative baseline and month 6 after surgery measurements revealed that both groups found significant improvements in IOP, PAS, BCVA and the number of glaucoma drugs (P

Background: Determining the strategy of surgical treatment for chronic angle closure glaucoma (CACG) is still important. Purpose: To assess the efficacy, rates of successful intraocular pressure (IOP) lowering and the increase in anterior chamber angle for laser peripheral iridotomy (LPI) in patients with CACG. Material and Methods: We examined 31 patients (31 eyes; 18 women and 13 men) who had undergone LPI for CACG. Patient age ranged from 49 to 77 years (mean age, 64.8 ± 5.3 years). The indication for LPI was an anterior chamber angle of Shaffer grade 2 to 3 and the presence of optic neuropathy. Mean Maklakoff intraocular pressure (IOP) was 23.4 ± 1.2 mmHg. Results: Thirteen patients required surgery during the follow-up after LPI. Particularly, 10 eyes required phacoemulsification (PHACO) only, and 3 eyes, PHACO plus goniosynechialysis (GSL), because of decompensated IOP and an anterior chamber angle narrower than Shaffer grade 2 by gonioscopy. Kaplan-Meier survival analysis showed that the rates of successful IOP lowering for laser peripheral iridotomy (without the need for surgery, PHACO alone or PHACO plus GSL) at 12 months, 24 months and 36 months were 87.1%, 71.0% and 58.06%, respectively. Conclusion: The LPI is effective for opening the anterior chamber angle and reducing IOP over 6 months, but is less effective and does not allow opening the anterior chamber angle over a period exceeding 6 months. The LPI may be considered as a preparatory procedure in CACG, particularly in the presence of an acute angle-closure glaucoma attack in the fellow eye.

Purpose: To compare the effects of phacoemulsification with intraocular lens implantation (phaco) combined with goniosynechialysis (phaco + GSL) versus phaco with trabeculectomy (phaco + trab) for the management of primary angle-closure glaucoma (PACG) refractory to peripheral anterior synechiae (PAS) of over 180°. Methods: This retrospective study followed 77 eyes of 77 patients for at least 6 months. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of glaucoma drugs, and PAS were recorded at the preoperative baseline and evaluated at each postoperative follow-up visit. The National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) was administered to patients enrolled in this study. Pearson's correlation analysis and multivariate linear analysis were performed to identify factors influencing changes in NEI VFQ-25 scores and to identify factors associated with increases in NEI VFQ-25 scores after the operation. Results: In total, seventy-seven eyes were included (43 with phaco + GSL and 34 with phaco + trab). Comparing preoperative baseline and month 6 after surgery measurements revealed that both groups found significant improvements in IOP, PAS, BCVA and the number of glaucoma drugs (P < 0.05). Baseline NEI VFQ-25 scores were similar in the two groups, but there was a significant difference in postoperative NEI VFQ-25 scores (74.47 ± 10.39 in phaco + GSL vs. 69.57 ± 8.54 in phaco + trab, P = 0.048 < 0.05), and the phaco + GSL group had better scores at the time of the last follow-up. The change in preoperative scores and the number of glaucoma drugs was significantly correlated with postoperative scores in the phaco + GSL group. Conclusion: Phaco + GSL treatment is as safe and effective as phaco + trab for refractory PACG patients, and patients' subjective experience improved significantly after phaco + GSL surgery. [ABSTRACT FROM AUTHOR]

AIM: To investigate the surgical outcomes of patients with chronic angle-closure glaucoma (CACG) treated with phacoemulsification (phaco)/endocyclophotocoagulation (ECP) with and without endoscopic goniosynechialysis (E-GSL). METHODS: A retrospective, nonrandomized, comparative case series was conducted. Patients with CACG who underwent phaco in combination with either ECP alone (ECP group) or GSL with ECP (E-GSL group) from 2018 to 2019 were followed for 12mo and reviewed. Clinical features and outcomes were identified and analyzed. The ECP and E-GSL groups were matched in age and baseline intraocular pressure (IOP). Changes in IOP, mean of visual acuity (VA), peripheral anterior synechiae (PAS) formation, and the number of glaucoma medications was examined. RESULTS: The ECP group included 32 eyes of 27 patients, and the E-GSL group included 32 eyes of 26 patients. The preoperative baseline IOP was 22.18±6.48 mm Hg in the ECP group and 22.95±6.71 mm Hg in the E-GSL group (P=0.644). The mean IOP reduction was 26.2% in the ECP group and 41.6% in the E-GSL group at 12mo. The mean postoperative VA (logMAR units) at 12mo was 0.47 in the ECP group and 0.36 in the E-GSL group. The reduction in PAS formation and the number of glaucoma medications was also higher in the ECP group than E-GSL group at 12mo. CONCLUSION: The phaco/ECP and phaco/E-GSL groups both achieve a significant reduction in IOP without complications associated with traditional glaucoma filtration surgeries.

Aim. To study the degree of angle opening and the decrease of intraocular pressure in primary angle-closure glaucoma (PACG) after cataract phacoemulsification and cataract phacoemulsification with goniosynechialysis (phaco + GLS). Materials and Methods. The study involved 28 patients (28 eyes) with primary chronic angle-closure glaucoma. The patients were divided into two groups, group 1 of 15 patients undergoing phaco with posterior chamber IOL implantation, and group 2 of 13 patients undergoing phaco with IOL implantation and GLS. The patients were followed for 24 months. Phaco was indicated in cases with IOP above 22 mmHg, appositional anterior chamber angle closure, and optic neuropathy; Phaco with GSL was indicated in cases of synechial angle closure and IOP above 22 mmHg Results. In group 1 after Phaco, postoperative anterior chamber angle opening was >20° in all quadrants. Postoperative IOP after 24 month follow-up it decreased by 32,6 % from the preoperative levels. In group 2 after Phaco+GSL, anterior chamber angle opened at least to 20° in three or more quadrants in all cases. Postoperative IOP after 24 month follow-up it decreased by 33.0% from the preoperative levels. Conclusions. Thus, phacoemulsification is an efficient procedure for PACG and appositional angle closure, leading to reopening of the anterior chamber angle with significant IOP reduction. Phacoemulsification alone does not lead to reopening of anterior chamber angle in cases with synechial angle closure, necessitating a combined surgery of phacoemulsification with GSL.

Purpose: To explore the course of a pseudophakic and pseudoiridic 61-year-old man with a history of open angle glaucoma in his right eye who developed a sub-totally secluded pupil then later presented with angle closure, a significant pressure spike, and a marked myopic refractive shift, consistent with aqueous misdirection. Observations: Goniosynechialysis, surgical removal of much of the native peripheral iris, and zonulohyaloidectomy led to a return to his prior refraction and improve intraocular pressure (IOP) control. Conclusions and Importance: This case demonstrates that a diagnosis of aqueous misdirection should not be disregarded in the presence of a prior vitrectomy and that aqueous misdirection should be strongly considered in cases of elevated IOP with a patent peripheral iridotomy, myopic shift and angle narrowing.

We aimed to observe changes in angle width and choroidal thickness (CT) before and after phacoemulsification intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) in patients with primary angle-closure glaucoma (PACG) complicated by cataracts. This prospective cohort study included 60 patients with PACG complicated by cataracts from the Department of Ophthalmology of Shaoxing People's Hospital, China. Patients underwent PEI combined with GSL (PEI-GSL group) or laser peripheral iridotomy (LPI) followed by PEI (PEI group). Intraocular pressure (IOP) and endothelial counts were significantly decreased in both groups after surgery, while best-corrected visual acuity and central anterior chamber depth were significantly increased. However, there were no significant differences between the two groups. The opening degrees of room corners at 12, 3, 6, and 9 o'clock were recorded as AA12, AA3, AA6, and AA9, respectively. Anterior chamber depth was significantly increased postoperatively compared to preoperatively in both groups, with no significant between-group differences (all ps > 0.05). At 1, 3, and 6 months postoperatively, the width at AA12, AA3, and AA9 points was higher in the PEI-GSL group than in the PEI group (all ps < 0.05). Significant between-group differences at AA6 were observed preoperatively (p = 0.023) and at 1 (p = 0.027) and 3 (p = 0.033) months postoperatively but not at 6 months postoperatively (p = 0.055). CT was smaller postoperatively than preoperatively (all ps < 0.001). The present study suggests that patients with PACG who underwent PEI with or without GSL had reduced IOP and CT after surgery. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of preoperative intravenous mannitol on the capsulorhexis process and intraoperative complications in patients with primary angle-closure glaucoma (PACG)., Methods: In this prospective randomized controlled trial, 65 PACG eyes were randomized into the mannitol and control groups. The capsulorhexis duration, number of forceps grasps, need for viscoelastic re-injection, and intraoperative complications were recorded., Results: The mannitol group had a significantly shorter capsulorhexis duration and fewer forceps grasps of the capsule. All intraoperative complications (18.2%) occurred in the control group. The patients with intraoperative complications had significantly higher intraocular pressure and lower best-corrected visual acuity than those without complications after surgery. Multivariate analysis found that intravenous mannitol (odds ratio [OR] = -14.263; 95% confidence interval [CI] =-26.713 to -1.813) reduced the capsulorhexis duration, whereas zonulopathy (OR = 14.477, 95% CI = 2.622-26.331) prolonged the duration., Conclusion: Preoperative intravenous mannitol can reduce the risk of intraoperative complications and improve postoperative outcomes in patients with PACG. Factors including anterior chamber depth, incision location and method, and the zonule status significantly influence the capsulorhexis process., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article

AIM: To observe the changes of visual acuity, intraocular pressure(IOP)and anterior chamber structure after phacoemulsification intraocular lens(IOL)implantation and goniosynechialysis in acute angle-closure glaucoma with cataract.METHODS: A prospective study. Totally 80 eyes with acute primary angle-closure glaucoma(APACG)and cataract were selected in our hospital from August 2019 to February 2021. All study underwent phacoemulsification IOL implantation and goniosynechialysis. Visual acuity, IOP, anterior chamber distance(ACD), trabecular iris angle(TIA)and angle opening distance(AOD500)were measured before and 1wk, 1, 3 and 6mo after surgery. Four quadrant angle classifications of upper, lower, nasal and temporal were determined by Scheie classification method and the measured values were statistically analyzed.RESULTS: The postoperative corrected visual acuity in 1wk, 1, 3 and 6mo were improved than preoperative, there were no statistically significant differences between each postoperative period(P>0.05). The IOP in postoperative 1wk, 1, 3 and 6mo were reduced than preoperative, there were not significantly different between each postoperative period(P>0.05). The ACD in postoperative 1wk, 1, 3 and 6mo were deepen than preoperative, there were not significantly different between each postoperative period(P>0.05). The TIA in postoperative 1wk, 1, 3 and 6mo were widened than preoperative, there were not significantly different between each postoperative period(P>0.05). The AOD500 in postoperative 1wk, 1, 3 and 6mo were increased than preoperative, there were not significantly different between each postoperative period(P>0.05). The depth of anterior chamber angle in four quadrants were deepened combined with the depth in postoperative 1wk, 1, 3 and 6mo(P

Background: Determining the strategy of surgical treatment for chronic angle closure glaucoma (CACG) is still important. Purpose: To assess the efficacy, rates of successful intraocular pressure (IOP) lowering and the increase in anterior chamber angle for laser peripheral iridotomy (LPI) in patients with CACG. Material and Methods: We examined 31 patients (31 eyes; 18 women and 13 men) who had undergone LPI for CACG. Patient age ranged from 49 to 77 years (mean age, 64.8 ± 5.3 years). The indication for LPI was an anterior chamber angle of Shaffer grade 2 to 3 and the presence of optic neuropathy. Mean Maklakoff intraocular pressure (IOP) was 23.4 ± 1.2 mmHg. Results: Thirteen patients required surgery during the follow-up after LPI. Particularly, 10 eyes required phacoemulsification (PHACO) only, and 3 eyes, PHACO plus goniosynechialysis (GSL), because of decompensated IOP and an anterior chamber angle narrower than Shaffer grade 2 by gonioscopy. Kaplan-Meier survival analysis showed that the rates of successful IOP lowering for laser peripheral iridotomy (without the need for surgery, PHACO alone or PHACO plus GSL) at 12 months, 24 months and 36 months were 87.1%, 71.0% and 58.06%, respectively. Conclusion: The LPI is effective for opening the anterior chamber angle and reducing IOP over 6 months, but is less effective and does not allow opening the anterior chamber angle over a period exceeding 6 months. The LPI may be considered as a preparatory procedure in CACG, particularly in the presence of an acute angle-closure glaucoma attack in the fellow eye. [ABSTRACT FROM AUTHOR]

AIM: To observe the clinical effect of femtosecond laser-assisted phacoemulsification combined with goniosynechialysis in the management of acute angle-closure glaucoma with cataract.METHODS:Retrospective study. From March 2019 to April 2021, 34 eyes of 29 acute angle-closure glaucoma with cataract patients were performed femtosecond laser-assisted phacoemulsification combined with goniosynechialysis. Best corrected visual acuity(BCVA), intraocular pressure(IOP), grading of chamber angle, central anterior chamber depth, corneal endothelial cell count and central corneal thickness were mesaured and analyzed preoperatively and at 1d, 1wk, 1mo.The postoperative complications were analyzed.RESULTS: There was a statistically significant difference between preoperative and postoperative BCVA at 1mo(Z= -5.126, P0.05). Postoperative satisfaction was high without serious complications.CONCLUSION:Femtosecond laser-assisted phacoemulsification combined with goniosynechialysis may be an effective treatment option for acute angle-closure glaucoma complicated with cataract, is safe, effective and has fewer complications.

Ahmed Al Habash,1 Wael Otaif,2 Abdulaziz Ismail Al Somali,3 Ziad Khoueir4,5 1Department of Ophthalmology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Department of Ophthalmology, King Khalid University, Abha, Saudi Arabia; 3Department of Ophthalmology, King Faisal University, Al Ahsa, Kingdom of Saudi Arabia; 4Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon; 5Saint- Joseph University, Faculty of Medicine, Beirut, LebanonCorrespondence: Ahmed Al HabashDepartment of Ophthalmology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, PO Box 31010, Dammam 31952, Saudi ArabiaTel +966507017777Email ahmedalhabash@gmail.comPurpose: To report the efficacy and safety of MicroPulse transscleral laser therapy (TLT) and Kahook Dual Blade excisional goniotomy and goniosynechialysis combined with phacoemulsification for chronic angle-closure glaucoma (ACG).Patients and Methods: A 39-year-old hyperopic female with a known history of ACG presented with a 2-week history of blurry vision, headache, and photophobia in the right eye (RE) following surgical peripheral iridectomy at another hospital. On examination, her uncorrected visual acuity was 20/50 in the RE, and 20/25 in the left eye (LE). Goldman applanation tonometry revealed an intraocular pressure (IOP) of 51 mmHg in the RE and 12 mmHg in the LE. Ocular examination of the RE revealed conjunctival hyperemia, corneal edema, shallow anterior chamber, posterior synechia, mid-dilated non-reactive pupil, and early cataractous changes. Anterior segment examination findings in the LE were normal except for a shallow anterior chamber. Gonioscopy revealed a closed angle (Schaffer grade 0) with 360° peripheral anterior synechia in the RE and a narrow angle (Schaffer grade 2) in the LE. The cup-to-disc ratios were 0.5 RE and 0.3 LE. The patient underwent MicroPulse TLT with phacoemulsification, Kahook Dual Blade-assisted goniosynechialysis, and excisional goniotomy in the RE.Results: At the 1-year follow-up, her IOP remained stable without the need for antiglaucoma medications. No further optic nerve or visual field deterioration was noted.Conclusion: MicroPulse TLT combined with phacoemulsification and Kahook Dual Blade-assisted goniosynechialysis and excisional goniotomy safely reduced IOP and the need for antiglaucoma medications in chronic ACG, avoiding the complications associated with incisional glaucoma surgery.Keywords: goniosynechialysis, Kahook Dual Blade, MicroPulse transscleral laser therapy, angle-closure glaucoma

Background: To date, no universal surgical strategy exists for primary angle closure glaucoma (PACG). Purpose: To assess the clinical efficacy and hypotensive effect of phacoemulsification (phaco) combined with goniosynechialysis (GSL) for the treatment of PACG. Material and Methods: Nine patients (9 eyes; mean age, 63.4 ± 9.6 years) with chronic angle-closure glaucoma who were under our observation were included in this study. Of these, 8 (8 eyes) underwent phaco-GSL, and one (1 eye) underwent GSL at some time after phaco. Failure to control IOP (the IOP higher than 22 mmHg on maximal tolerable hypotensive therapy) and synechial closure of the anterior chamber angle was the indication for surgery. Results: Using the Mori goniolens was helpful in performing GSL in all anterior chamber quadrants. The IOP was 26.33 ± 3.6 mmHg before surgery, 18.44 ± 0.88 mmHg on day 7, 18.44 ± 1.13 mmHg on day 30, and 18.11 ± 1.5 mmHg on day 90. Visual acuity improved from 0.09 ± 0.05 to 0.35 ± 0.2. Mean number of hypotensive medications decreased from 2.8 ± 0.92 pre-surgery to 0.77 ± 0.83 post-surgery. Conclusion: Phacoemulsification in combination with GSL has a good hypotensive effect. Intraoperative visualization of the anterior chamber angle and transection of synechia in all quadrants allows improving the efficacy of GSL procedure.

AIM: To assess the clinical efficacy of phacoemulsification, intraocular lens implantation with goniosynechialysis(PEI+GSL)for acute angle closure glaucoma(AACG)and cataract with extensive angle closure synechiae.METHODS: A retrospective study, we studied 35 eyes of 32 patients with AACG and cataract in our hospital. The extent of anterior chamber angle-closure synechiae was defined as an eye with >180°. All patients underwent PEI+GSL and completed an ophthalmologic examination including vision, intraocular pressure(IOP), anterior chamber depth(ACD), angle-opening distance(AOD500), trabecular-iris space area(TISA500)were observed at 1d, 1wk, 1mo and 3mo after cataract surgery. The angle closure range and retinal nerve fiber layer(RNFL)thickness changes at postoperative 1mo and 3mo were observed, and recorded complications.RESULTS: Postoperative 3mo BCVA(0.334±0.154)and IOP(14.63±3.59mmHg)were improved compared with preoperative(0.914±0.290, 42.54±8.06mmHg)(P500 and TISA500(0.308±0.014, 0.315±0.015mm, 0.134±0.013, 0.139±0.018mm2)were significantly increased compared with preoperation. The extent of angle closure with gonioscopy(72.32±28.33°)decreased compared preoperation(215.29°±30.66°), and RNFL thickness thinner than preoperation(P500 and TISA500 for both nasal and temporal were negatively correlated with IOP, but not with changes in ACD, and no significant complications occurred in the 3mo after surgery.CONCLUSION: The treatment of PEI+GSL can improve vision, deeper ACD and effectively open ACA in the early stage, thus controlling IOP.

The lens plays a crucial part in the etiology of primary angle-closure glaucoma(PACG). The changes in the thickness and position of the lens have been related to common structural deviations observed in PACG eyes such as: shallow anterior chamber, pupillary block and crowded anterior chamber angle. Lens extraction has long been used to treat PACG, which combined with anti-glaucoma surgeries remains a commonly employed therapy. This article aims to summarize the medical outcome and role of phacoemulsification with or without anti-glaucoma surgeries in the treatment of PACG.

AIM: To observe the safety and efficacy of phacoemulsification combined with goniosynechialysis in treatment of primary angle-closure glaucoma(PACG)with intraocular pressure out of control after trabeculectomy.METHODS: We retrospectively reviewed 31 cases(32 eyes)of acute or chronic PACG with uncontrolled intraocular pressure from June 2015 to April 2019. The history of trabeculectomy was 3mo to 12a. All of them were complicated with different degrees of cataract. Phacoemulsification combined with intraocular lens implantation and goniosynechialysis were performed in all patients. The patients were followed up for 6mo. The IOP, the best corrected visual acuity(BCVA), the depth of central anterior chamber and the peripheral anterior synechia(PAS)of anterior chamber angle were observed preoperatively and 1, 3 and 6mo postoperatively. The corneal endothelial cell count and the thickness of the retinal nerve fiber layer(RNFL)were observed 6 months after the operation. The complications during and after operation were observed. RESULTS: The IOP was significantly decreased on 1wk, 1, 3, 6mo postoperative(14.38±3.04, 18.26±3.12, 15.21±2.84, 15.42±3.09mmHg)compared with preoperative(36.52±12.26mmHg)(PPP>0.05). Corneal edema in 7 eyes and anterior chamber inflammatory exudation in 3 eyes disappeared within 7d after treatment. The IOP of 3 patients(3 eyes)with chronic PACG was 21-30mmHg which was controlled by 1 to 3 anti-glaucoma eye drops.CONCLUSION: Phacoemulsification combined with goniosynechialysis is a safe and effective method in the treatment of PACG combined with cataract with intraocular pressure out of control after trabeculectomy.

Purpose: To report the preliminary results of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with chronic angle-closure glaucoma (CACG). Methods: Retrospective, single-center, case series of GATT procedures is performed on patients with CACG. The primary outcome was intraocular pressure (IOP). Success was defined as IOP reduction >30% from baseline at 6 and 12 months with (qualified) or without (complete) glaucoma medication. Secondary outcomes were best-corrected visual acuity (BCVA), visual field (VF), peripheral anterior synechiae (PAS), medications, and complications. Results: Fifteen eyes (15 patients) with a minimum follow-up of 1 year were included for the analysis. Preoperatively, the mean (±SD) IOP was 30.27 (±4.20) mmHg and 15.20 (±2.08) mmHg at 1 year postoperatively (p<0.001). The mean (±SD) percentage of IOP reduction from baseline was 49% (±9.41). At 6 and 12 months, the success rate complete and qualified was 93% (73% and 20%) and 100% (73% and 27%), respectively. BCVA and VF mean deviation were comparable before and after surgery (p=0.167 and p= 0.710, respectively). The median (range) number of glaucoma drugs decreased from 3 (3–4) before to 0 (0–2) after GATT (p<0.001). The absence of PAS was observed in 80% of patients after surgery. Transient hyphema was a common complication requiring aspiration in one case. Conclusion: At 12 months of follow-up, our preliminary results indicate that GATT in CACG effectively reduces the IOP and the number of medication with a low risk of complications. Following ab interno trabeculotomy, an open-angle without PAS was achieved in the majority of patients. Trial registration number: nr. 2016/0010904 [ABSTRACT FROM AUTHOR]

AIM: To evaluate the efficacy of phacoemulsification and intraocular lens implantation combined with goniosynechialysis in the treatment of chronic angle-closure glaucoma.METHODS: Thirty-three patients(35 eyes)with primary chronic angle-closure glaucoma and cataract were enrolled in the Department of Ophthalmology, Xi'an First Hospital from May 2018 to November 2018. The best corrected visual acuity, intraocular pressure, central anterior chamber depth, angle-opening distance at 500μm from the scleral spur, trabecular iris angle, angle closure or adhesion were compared between preoperative and postoperative 6mo.RESULTS: The best corrected visual acuity of 34 eyes(97%)was improved after operation. 27 eyes(77%)did not need any intraocular pressure lowering drugs after operation, and the intraocular pressure was kept below 21mmHg. The average value of anterior chamber depth, angle-opening distance at 500μm from the scleral spur and trabecular iris angle(2.04±0.31mm, 0.132±0.033μm, 15.44°±3.10°)before operation were significantly lower than the postoperative mean values(3.26±0.29mm, 0.407±0.038μm, 34.26°±3.60°). The range of angle closure or adhesion decreased after operation, and the difference was statistically significant. CONCLUSION: Phacoemulsification with intraocular lens implantation and goniosynechialysis is an effective way to treat primary chronic angle-closure glaucoma.

AIM: To analyze the efficacy and safety of goniosynechialysis or trabeculectomy combined with phacoemulsification(Phaco)in the treatment of primary angle-closure glaucoma(PACG)and coexisting cataract.METHODS: A retrospective study. A total of 108 eyes of 96 PACG patients with age-related cataract admitted to our hospital from March 2013 to February 2018 were collected. Goniosynechialysis combined with Phaco(group A)was performed in 50 cases(54 eyes), and trabeculectomy combined with Phaco(group B)in 46 cases(54 eyes). The best corrected visual acuity, intraocular pressure, central anterior chamber depth, corneal endothelial cell count, failure rate, recurrence rate, operation time and average hospitalization days were compared between the two groups.RESULTS: After at least 12mo of follow-up(till February 2019), the best corrected visual acuity of the two groups was significantly improved, and the intraocular pressure was significantly lower than preoperation(PP=0.004), while the best corrected visual acuity in group B was lower than that in group A(P=0.012). The central anterior chamber depth of the two groups was significantly deeper than pre-operation(PP=0.231). At the last follow-up, there was no significant difference in the percentage of hexagonal cells(P>0.05). The operation time of group A was shorter(P=0.022), and the average hospitalization days were significantly lower than those of group B(PP=0.243)and recurrence rate(P=0.113)between the two groups.CONCLUSION: Goniosynechialysis combined with Phaco in the treatment of PACG and coexisting cataract has similar efficacy and safety to trabeculectomy combined with Phaco. The former may achieve better visual acuity, shorter operation time and shorter hospitalization time, while the latter has lower failure rate and recurrence rate, which is more suitable for patients with chronic PACG.

AIM: To compare the benefits and potential harms of routine phacoemulsification (phaco) alone and combined surgery with goniosynechialysis (GSL) for angle-closure glaucoma (ACG) and coexisting lens opacity, as shown in different randomized controlled trials (RCTs). METHODS: A systematic review was conducted searching several databases including PubMed, Cochrane Library, EMBASE, ClinicalTrials.gov from the inception to September 2018 for RCTs with data published on the effects and safety of phaco and intraocular lens implantation combined with GSL or routine cataract surgery alone. Several studies were recruited which reported data at baselines and postoperative follow-up, including the mean values of postoperative intraocular pressure (IOP) and mean numbers of anti-glaucoma medications using postoperatively. The numbers of complications happening were also included. Fixed-effect and random-effect models were applied, and the quality of evidence was evaluated. RESULTS: Analysis of the seven included RCTs, with a total number of 321 participants (358 eyes) diagnosed with ACG and cataract, received a solo procedure (phaco group) or a combined surgery (phaco-GSL group) randomly, and follow-up periods ranging from 2 to 12mo postoperatively. The involved studies showed that the mean value of IOP between the two groups at 3 (four studies, one study follow-up at 2mo postoperative was included), 6, 12mo postoperative were not significantly different. Only two studies reported the change in IOP value at 12mo compared with baseline but showed no significant differences between the two interventions. Although three studies did not have the significant difference in the number of medications using to reduce IOP at 3mo postoperatively, two studies reported that the participants using fewer anti-glaucoma medications at 12mo postoperative in the phaco group than in the phaco-GSL surgery group. CONCLUSION: The analysis provides a low to moderate-quality evidence that phaco-GSL surgery lead to an equivalent IOP-lowering effect. The phaco-GSL surgery may not help patients to reduce the consumption of anti-glaucoma eyedrops in the long period. The results of this analysis suggested that additional GSL may not be necessary for primary angle closure glaucoma (PACG) patients. Further studies, especially RCTs with more participants and longer follow-up time were needed to provide more sufficient data.

AIM: To explore the effect of phacoemulsification combined with goniosynechialysis or trabeculectomy on haemodynamics in patients with primary angle-closure glaucoma(PACG)and cataract.METHODS: Totally 94 patients(94 eyes)with PACG and cataract who were admitted to Bazhong Central Hospital from January 2015 to June 2017 were divided into phacoemulsification and goniosynechialysis group(Observation group)and phacoemulsification with trabeculectomy group(Control group)by random number table method, 47 cases in each group. The indexes of curative effect were compared between the two groups.RESULTS:The peak systolic velocity(PSV)and end diastolic velocity(EDV)of Observation group were larger than those of Control group at 1mo and 3mo after surgery. The resistance index(RI)of Observation group was significantly less than that of Control group at 3mo after surgery, while anterior chamber depth and open degree of angle were larger than those of group B(PCONCLUSION:Both goniosynechialysis or trabeculectomy combined with phacoemulsification can effectively reduce intraocular pressure, and promote visual recovery. But goniosynechialysis can better promote opening of angle, and improve hemodynamics.

Abstract Background Patients with primary angle closure/glaucoma (PAC/PACG) with extensive peripheral anterior synechiae (PAS), and coexisting cataract, increasingly have been treated with phacoemulsification combined with goniosynechialysis (Phaco-GSL). Since the mechanisms of acute and chronic PAC/PACG may differ, the treatment effect of this procedure also may differ. The purpose of this study was to establish whether there was a difference in the therapeutic effect of Phaco-GSL on these two groups of patients, the results of which could provide clinical evidence for improvement in treatment protocols for patients with PAC/PACG and extensive PAS. Methods This study was a retrospective cohort study. Twenty-seven patients, 13 with acute PAC/PACG and 14 with chronic PAC/PACG, were treated surgically by Phaco-GSL. The intraocular pressure (IOP), surgical success rate, the need of medication, the extent of PAS, the time and the rate of recurrence of PAS (re-PAS) and other indicators were observed post-operatively for at least 3 months. Results After surgery, IOP decreased (preoperative vs postoperative: 29.77 ± 11.55 mmHg vs 14.92 ± 1.66 mmHg in the acute group and 26.00 ± 11.2 mmHg vs 14.93 ± 2.7 mmHg in the chronic group), the extent of PAS reduced (preoperative vs. postoperative: 314.23 ± 49.07° vs 116.54 ± 73.78° in the acute group and 285.00 ± 53.28° vs 156.43 ± 56.35° in the chronic group), the topical and systemic anti-glaucoma drug requirements decreased, in both groups and in the acute group, respectively. Compared with the acute group, the success rate (acute vs chronic: 100% vs 64.3%) was lower in the chronic group, while the incidence of re-PAS (acute vs chronic: 30% vs 83.3%) were higher in the chronic group. All differences mentioned above were statistically significant (p

Purpose: To evaluate surgical outcomes of the four common procedures utilized for primary angle-closure glaucoma (PACG). Methods: A retrospective study of survival rate in surgical management of PACG was conducted in a referral eye center. One hundred and ninety-nine eyes from 173 PACG patients were collected for chart review. The procedures used were phacoemulsification (PE), combined PE with goniosynechialysis (PE-GSL), combined PE with trabeculectomy (PE-Trab), and trabeculectomy alone. Failure was defined as postoperative IOP > 21 mmHg in patients who needed second surgical intervention or those who had IOP < 5 mmHg with loss of light perception. Cumulative survival rates, risk of surgical failure, and complications were analyzed. Results: PE, PE-GSL, PE-Trab, and trabeculectomy were performed in 84 eyes (42.2%), 76 eyes (38.2%), 21 eyes (10.6%), and 18 eyes (9%), respectively. Cumulative survival rates at 60 months were 13%, 55%, 42% and 43%, respectively. Cox regression analysis indicated that each mmHg IOP increased, the risk of surgical failure decreased by 13% (adjusted hazard ratio (HR) 0.87; 95%CI: 0.84– 0.93, p< 0.001). Conclusion: Real-world surgical outcomes of PACG showed that PE alone had a low survival rate of 13% in 60-month follow-up whereas PE-GSL achieved the highest rate of 55%. PE-GSL should be initially considered for management of PACG, since it can restore and sustain the physiologic aqueous pathway and preserve the conjunctiva for future filtering surgery if needed. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the additional intraocular pressure (IOP) lowering effect of gonioscopy-assisted transluminal trabeculotomy (GATT) to contemporary goniosynechialysis (GSL) in endeavouring to abolish subsequent occlusion after chronic iridotrabecular contact in primary angle closure (PAC) patients. Methods: A retrospective case series of all PAC eyes underwent GATT + GSL with or without phacoemulsification and intraocular lens implantation (PEA + IOL) from December 2016 to May 2018 were recruited. IOP and the number of anti-glaucoma medications were compared pre- and post-operatively by Wilcoxon signed-rank test. Repeated measure ANOVA was used to evaluate the difference in IOP change after the operation between a subgroup of operations (GATT + GSL + PEA + IOL and GATT + GSL) and the arc of cutting of trabeculotomy. Results: Thirty-nine eyes of 30 patients, 37 chronic angle closure glaucoma (CACG), 1 acute primary angle closure (APAC), and 1 plateau iris syndrome were recruited. Mean preoperative IOP was 21.8 ± 5.4 mmHg. Mean post-operative IOP was lowered to 15.1 ± 3.8 mmHg at 1 month, 14.4 ± 1.2 mmHg at 3 months, 14.8 ± 2.1 mmHg at 6 months, 14.5 ± 0.8 mmHg at 1 year, and 15 at 2 years (P < 0.001, P = 0.0012, P = 0.001, P = 0.028, and P = 0.317 (n = 1), consecutively). Mean of overall post-operative IOP at the last follow-up was 15.1 ± 4.4 mmHg (P < 0.001). Mean preoperative number of anti-glaucoma medications was 3.5 ± 1.4. Mean post-operative number of anti-glaucoma medications was reduced to 1.5 ± 1.4 at 1 month, 0.9 ± 0.9 at 3 months, 1.4 ± 1.4 at 6 months, 1.5 ± 0.5 at 1 year, and 2 at 2 years (P < 0.001, P = 0.01, P = 0.002, P = 0.028, and P = 0.317 (n = 1), respectively). Mean of overall post-operative number of anti-glaucoma medications was 1.1 ± 1.2 (P < 0.001). There was no significant difference found between the IOP lowering effect in subgroup analysis. Conclusion: GATT + GSL could significantly reduce IOP and number of anti-glaucoma medications from baseline compared to the last follow-up; however, there seemed not to be any superiority to the effects found in previous studies reported about GSL + PEA or PEA alone in PAC patients. [ABSTRACT FROM AUTHOR]

Purpose: Angle closure (AC) is a rare condition in young people. In adults with AC, lens extraction and goniosynechialysis (LE-GSL) are effective in restoring angle anatomy and function. However, the efficacy of LE-GSL is poorly understood in the juvenile population. In this study, we report the efficacy and safety of LE-GSL in a series of young patients with AC. Methods: We reviewed the medical records of consecutive patients with AC. Eyes were included if aged 24 mmHg and (1) less than 180° of visible trabecular meshwork, or (2) any peripheral anterior synechiae noted on gonioscopy, or (3) iridocorneal apposition prior to dilation > 180° identified on anterior segment imaging. Results: A total of 11 eyes (7 patients) were included. The mean ages of diagnosis and LE-GSL were 19.0 and 21.2 years, respectively. Of the 11 eyes, 8 had a history of laser retinal ablation for the treatment of retinopathy of prematurity (ROP, 72.7%). Intraoperatively, 7 eyes received intraocular lens (63.3%), 6 had concurrent vitrectomy (54.5%), and 4 had concurrent endocyclophotocoagulation (36.4%). Following LE-GSL, visual acuity (VA) improved from a mean preoperative LogMAR of 0.88 (20/150 Snellen equivalence) to a mean LogMAR of 0.68 (20/100 Snellen equivalence, P = 0.029). IOP significantly decreased from 18.2 mmHg (Tmax 38.4±12.2 mmHg) preoperatively to a mean of 11.3 mmHg postoperatively (P = 0.009). The number of glaucoma medications was significantly reduced from a mean of 2.4 preoperatively to no medications at final follow-up (mean duration of 13.7 months, P

Purpose: To compare surgical outcomes of patients after phacoemulsification with goniosynechialysis (phaco/GSL) versus phaco with GSL and endocyclophotocoagulation (phaco/GSL/ECP) in patients with chronic angle closure glaucoma (CACG) through 12-month follow-up. Methods: A retrospective, nonrandomized, comparative case series was performed. Patients with CACG who underwent phaco in combination with either GSL alone (group 1) or GSL with ECP with intracameral injection of kenalog (group 2) from 2011 to 2018 were included. Group 1 included 6 eyes of 6 patients and group 2 included 11 eyes of 10 patients. All surgeries were performed by a single surgeon (RSA). Primary outcome measures included changes in intraocular pressure (IOP), visual acuity (VA), failure based on IOP (>18 or

AIM: To study the effect of two kinds of phacoemulsification combined with goniosynechialysis for primary angle-closure glaucoma with cataract. METHODS: Phacoemulsification combined with goniosynechialysis was performed in 60 patients 62 eyes for primary angle-closure glaucoma with cataract. They were randomly divided into two groups, 31 eyes underwent phacoemulsification with goniosynechialysis combined with I/A catheterization were performed in Group A; in Group B, 31 eyes were performed phacoemulsification with goniosynechialysis combined with viscoelastics. Best corrected visual acuity, the intraocular pressure, anterior chamber depth, anterior chamber angle width and pupil size were measured before the operation, and 3mo after the operation.RESULTS: Intraocular pressure of all cases were reduced obviously after the operation(PPP>0.05), but, Group A was superior to Group B in anterior chamber angle width(PCONCLUSION: Two kinds of goniosynechialysis combined with phacoemulsification in the treatment of primary acute angle-closure glaucoma with cataract are effective. Among them, the goniosynechialysis with I/A was more effective to increase the anterior chamber angle width.

AIM: To evaluate the incidence of supraciliochoroidal fluid(SCF)within 1wk after phacoemulsification combined with goniosynechialysis by anterior segment optical coherence tomography(AS-OCT). METHODS: AS-OCT was used to analyze the incidence of SCF in 40 eyes of 40 patients who received phacoemulsification combined with goniosynechialysis from January 2016 to June 2017. All the patients were diagnosed with primary acute angle-closure glaucoma(PACG)along with cataract. Patients with SCF occurring in 1wk after surgery were included in the SCF group(10 cases with 10 eyes), and patients without SCF were included in the non-occurrence SCF group(30 cases with 30 eyes). Data of intraocular pressure(IOP), central depth of anterior chamber, central macular thickness(CMT), and best corrected visual acuity(BCVA)were collected to further analysis. RESULTS: All the 40 eyes displayed no SCF before surgery. SCF was detected in 10 eyes(25%), which first occurred on 1d(2 eyes), 3d(7 eyes), and 1wk(1 eye)within 1wk postoperatively. SCF was detected in four(7 eyes), two(2 eyes), and one quadrant(1 eye). The whole 10 eyes showed grade Ⅰ(8 eyes)or grade Ⅱ detachment(2 eyes), with no eyes showing grade Ⅲ detachment. Nine eyes had showed no SCF by 4wk, and all SCF disappeared on 8wk. The lowest IOP was significantly lower in eyes with SCF(8.9±0.9mmHg)than in those without(12.5±2.6mmHg)(PPrs=0.838, PCONCLUSION: SCF can be detected frequently with AS-OCT at the very early stages after phacoemulsification combined with goniosynechialysis(within 1wk postoperatively), which has fine clinical value.

AIM: To explore whether the drainage angle could be reopened by surgery in patients with severe acute angle-closure glaucoma at “the greatest degree” of angle closure, and to study the treatment methods, such as double-paracentesis, phacoemulsification combined with goniosychialysis, and the effectiveness. METHODS: Retrospective observational case series. From November 2008, to November 2015, there were 33 patients with severe acute angle-closure glaucoma and 360° angle closure. Drug treatment showed no effect on them, so initial double-paracentesis(anterior chamber paracentesis combined with vitreous paracentesis)was applied. Then, either phacoemulsification combined with goniosychialysis or trabeculectomy surgery was performed after 7-14d, which was chosen based on the result of gonioscope during the surgery. The intraocular pressure, angle changes, and complications were observed. The follow-up period was 6mo to 3a. RESULTS: Of 33 participants enrolled, 32 had normal intraocular pressure after “double-paracentesis”(2 had normal intraocular pressure after laser peripheral iridotomy). The mean intraocular pressure was significantly reduced from 53.4±10.7mmHg to 16.9±13.2mmHg(t=9.21,Pt=0.38,P>0.05). One patient had abnormal intraocular pressure until 30d after phacoemulsification. Every participant had 360° angle closed before “double-paracentesis”, 32 patients had opened angle(mean 131.8°±111.3°)after “double-paracentesis” and mean(228.6°±108.3°)during phacoemulsification, and mean(234.6°±107.2°)at 3mo after phacoemulsification. There was a significant difference between the post-paracentesis and intraoperative values(t=4.52, Pt=0.46, P>0.05). No patients had serious adverse events. CONCLUSION: For the “maximum degree” angle closure of severe acute angle-closure glaucoma, “double-paracentesis” combined with phacoemulsification can be chosen to open the angle gradually, and reduce intraocular pressure in vast majority of patients.

Sira Arunmongkol, Yanin Suwan, Wasu Supakontanasan, Suthaphat Nilphatanakorn, Chaiwat Teekhasaenee Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Introduction: We report a rare case of unexpected gross hyphema in the right eye (OD) and eight-ball hyphema in the left eye (OS) from a bilateral laser iridotomy in an acute primary angle-closure patient. We also demonstrated the effectiveness of the inferior full-thickness trabeculectomy with daily intracameral air injection as an alternative treatment in eight-ball hyphema. Case report: An 81-year-old Thai female presented with gross hyphema grade II OD and eight-ball hyphema with blood-stained cornea OS after laser iridotomy. The patient was scheduled for surgery and the preoperative blood test showed bicytopenia. We performed anterior chamber washout OD and an inferior full-thickness trabeculectomy with daily intracameral air injection OS. The hyphema completely resolved on the following day OD and 3 days after surgery OS. The inferior bleb OS did not raise with digital pressure and became nonfunctional in 7 days. No recurrent hyphema was found in both eyes (OU) during 6 months of follow-up. This patient was ultimately diagnosed with hypocellular myelodysplastic syndrome (MDS). Conclusion: Gross hyphema after laser iridotomy can be seen in patients with hypocellular MDS. The inferior full-thickness trabeculectomy is an alternative surgical procedure for an eight-ball hyphema. Keywords: gross hyphema, full-thickness trabeculectomy, primary angle-closure, goniosynechialysis

AIM: To investigate the influence of high perfusion irrigation during phacoemulsification on the postoperative visual function of patients with acute angle-closure glaucoma(AACG).METHODS: Totally 35 patients(37 eyes)with AACG with cataract were included to do the surgery of phacoemulsification with goniosynechialysis. They have been followed up for 6mo. The preoperative and postoperative(3mo and 6mo)best corrected visual acuity(BCVA), intraocular pressure, mean sensitivity(MS), mean defect(MD), and square root loss variance(sLV)were measured and compared.RESULTS: Compared with preoperative results, 3mo and 6mo BCVA were significantly improved and intraocular pressure was significantly reduced after operation, with statistically significant differences(PP>0.05). After surgery, 3mo and 6mo MS increased significantly, MD and sLV decreased significantly, and the difference was statistically significant(PP>0.05).CONCLUSION: The high perfusion irrigation during phacoemulsification does not damage the visual function of patients with AACG.

Purpose: We aimed to evaluate the efficacy and safety of effective goniosynechialysis (GSL) under an endoscopic view combined with phacoemulsification in residual angle-closure glaucoma with lens opacity. Methods: This was a retrospective study. Patients with residual angle-closure glaucoma, lens opacity, and uncontrolled intraocular pressure (IOP) who were receiving anti-glaucoma medications were selected to undergo effective GSL under an endoscopic view combined with phacoemulsification. Follow-up examinations were conducted until 6 months postoperatively. Results: Twenty-five eyes of 24 patients diagnosed with residual angle-closure glaucoma and lens opacity and peripheral anterior synechiae (PAS) at least ≥ 270° were included. Their mean age was 61.32 ± 6.11 years. Preoperatively, the mean (standard error) IOP was 29.69 (11.22) mmHg, and the median number of IOP-lowering medications used was 3.0. The decreases in the rates of IOP of the patients were 44.29%, 52.17%, 46.95%, 48.37%, and 47.29% at 1 day, 1 week, 1 month, 2.5 months, and 6 months after the surgery, respectively. At 6 months, the median number of IOP-lowering medications used decreased from 3 to 0 and the range of PAS compared to the baseline decreased from 312° to 107° (P < 0.001). We also found that 21/25 eyes achieved improved or stable visual acuity after surgery. Postoperative complications included transiently elevated IOP (12.0%), exudation (8.0%), and hyphema (4.0%). Conclusions: Phacoemulsification combined with effective GSL under an endoscopic view may reopen residual angle-closure glaucoma and reduce the number of IOP-lowering medications for up to 6 months. It is an effective and safe method for patients with residual angle-closure glaucoma and lens opacity. [ABSTRACT FROM AUTHOR]

Purpose: To report the efficacy and safety of MicroPulse transscleral laser therapy (TLT) and Kahook Dual Blade excisional goniotomy and goniosynechialysis combined with phacoemulsification for chronic angle-closure glaucoma (ACG). Patients and Methods: A 39-year-old hyperopic female with a known history of ACG presented with a 2-week history of blurry vision, headache, and photophobia in the right eye (RE) following surgical peripheral iridectomy at another hospital. On examination, her uncorrected visual acuity was 20/50 in the RE, and 20/25 in the left eye (LE). Goldman applanation tonometry revealed an intraocular pressure (IOP) of 51 mmHg in the RE and 12 mmHg in the LE. Ocular examination of the RE revealed conjunctival hyperemia, corneal edema, shallow anterior chamber, posterior synechia, mid-dilated non-reactive pupil, and early cataractous changes. Anterior segment examination findings in the LE were normal except for a shallow anterior chamber. Gonioscopy revealed a closed angle (Schaffer grade 0) with 360° peripheral anterior synechia in the RE and a narrow angle (Schaffer grade 2) in the LE. The cup-to-disc ratios were 0.5 RE and 0.3 LE. The patient underwent MicroPulse TLT with phacoemulsification, Kahook Dual Blade-assisted goniosynechialysis, and excisional goniotomy in the RE. Results: At the 1-year follow-up, her IOP remained stable without the need for antiglaucoma medications. No further optic nerve or visual field deterioration was noted. Conclusion: MicroPulse TLT combined with phacoemulsification and Kahook Dual Blade-assisted goniosynechialysis and excisional goniotomy safely reduced IOP and the need for antiglaucoma medications in chronic ACG, avoiding the complications associated with incisional glaucoma surgery. [ABSTRACT FROM AUTHOR]

Background: To date, no universal surgical strategy exists for primary angle closure glaucoma (PACG). Purpose: To assess the clinical efficacy and hypotensive effect of phacoemulsification (phaco) combined with goniosynechialysis (GSL) for the treatment of PACG. Material and Methods: Nine patients (9 eyes; mean age, 63.4 ± 9.6 years) with chronic angle-closure glaucoma who were under our observation were included in this study. Of these, 8 (8 eyes) underwent phaco-GSL, and one (1 eye) underwent GSL at some time after phaco. Failure to control IOP (the IOP higher than 22 mmHg on maximal tolerable hypotensive therapy) and synechial closure of the anterior chamber angle was the indication for surgery. Results: Using the Mori goniolens was helpful in performing GSL in all anterior chamber quadrants. The IOP was 26.33 ± 3.6 mmHg before surgery, 18.44 ± 0.88 mmHg on day 7, 18.44 ± 1.13 mmHg on day 30, and 18.11 ± 1.5 mmHg on day 90. Visual acuity improved from 0.09 ± 0.05 to 0.35 ± 0.2. Mean number of hypotensive medications decreased from 2.8 ± 0.92 pre-surgery to 0.77 ± 0.83 post-surgery. Conclusion: Phacoemulsification in combination with GSL has a good hypotensive effect. Intraoperative visualization of the anterior chamber angle and transection of synechia in all quadrants allows improving the efficacy of GSL procedure. [ABSTRACT FROM AUTHOR]

Objective To evaluate the clinical curative effect of phacoemulsification combined with goniosynechialysis for treating acute angle-closure glaucoma with cataract. Methods This retrospective study was performed to collect a total of 38 eyes of 38 patients with acute angle-closure glaucoma and cataract who underwent phacoemulsification combined with goniosynechialysis in the Fourth Affiliated Hospital of Kunming Medical University from January 2018 to June 2018. The change of intraocular pressure（IOP），the best corrected visual acuity（BCVA），central anterior chamber，peripheral anterior chamber（PAC）and the change of anterior chamber angle were followed up of 12 to 24 months. Results Preoperative intraocular pressure（IOP）were from 8.3 mmHg to 32 mmHg，and mean IOP was（17.67±4.76）mmHg，the first day after operation and the last follow-up of mean IOP was（13.63±5.82）mmHg and（12.25±4.54）mmHg. The IOP was obviously decreased after operation. The BCVA was significantly improved after operation. The central anterior chamber depth of preoperative patients was（1.42±0.34）mm. After surgery，the central anterior chamber depth was（3.41±0.13）mm，the central anterior chamber was significantly deeper than preoperative.The peripheral anterior chamber depth of all patients with preoperative was <1/2CT，and it deepened after operation，there were 29 eyes whose peripheral anterior chamber depth was more than lCT. There were 22 eyes whose preoperative angle-closure range >180°，they were partly opened after operation，and there were 25eyes whose anterior chamber angle were fully opened after operation. 4 eyes were implanted in tension ring during operation. After operation，5 eyes had slight corneal edema，3 cases of patients with anterior chamber exudative，they all get better after treatment. Conclusion Phacoemulsification combined with goniosynechialysis is safe and effective，but the choice of operation should be fully considered. [ABSTRACT FROM AUTHOR]

AIM: To explore the effect of phacoemulsification combined with goniosynechialysis for cataract patients with glaucoma. METHODS: From May 2013 to December 2014, 120 eyes of 113 patients with cataract and glaucoma admitted to our department were selected, and their clinical data were retrospectively analyzed. Among them, 88 eyes received phacoemulsification combined with goniosynechialysis(Group A), 32 eyes received phacoemulsification(Group B). All the patients were followed up at 1wk, 1, 2, and 6mo and 1a postoperatively. The visual acuity, intraocular pressure, visual field, anterior chamber depth and angle changes before and after the surgery were compared between the two groups. RESULTS: Vision: at each follow-up time point, their vision was improved significantly than before the surgery(PPPPPPPPPCONCLUSION: Compared with simply phacoemulsification, phacoemulsification combined with goniosynechialysis is safer, and has better effectiveness for cataract patients with glaucoma. In addition, the latter has advantages in increasing the depth of the anterior chamber, and improving the openness of angle, as well as improving the vision and visual field, while reducing the intraocular pressure.

A 48-year-old lady presented with bilateral symptomatic uveitis. She had bilateral cosmetic iris implantation 4 years ago. She underwent bilateral cosmetic iris explantation and goniosynechialysis to open up areas of angle compromise. This patient presented before significant angle compromise. This case report also serves to highlight the serious potential risks associated with cosmetic iris implantation. Patients with cosmetic iris implants should be warned of the potential complications and advised explantation at the earliest.