Effects Of Phacoemulsification Combined With Goniosynechialysis On Primary Angle-closure Glaucoma With Cataracts

Purpose: To observe the the efficacy and safety of phacoemulsification combined with goniosynechialysis(Phaco+GSL)on patients with primary angle-closure glaucoma(PACG)and cataract.Methods: A retrospective analysis was made on 49 eyes of 40 PACG patients with cataract in the Affiliated Hospital of Qingdao University from January 2018 to December 2018.Among them,17 cases(19 eyes)underwent phacoemulsification,intraocular lens implantation,and goniosynechialysis(Phaco+GSL group),23 cases(30 eyes)underwent phacoemulsification,intraocular lens implantation,and trabeculectomy(Phaco+Trab group).The best distance corrected visual acuity(BCVA),intraocular pressure,peripheral anterior synechiae(PAS),anterior segment structural parameters,optic disc parameters and visual field parameters,and complications between the two groups at 3 months after operation were compared.Results: BCVA(logMar)was significantly improved in Phaco+GSL group and Phaco+Trab group.The intraocular pressure in Phaco+GSL group decreased from 23.79±3.33 mmHg preoperatively to 13.84±1.63 mmHg 3 months postoperatively(P<0.01);the intraocular pressure in Phaco+Trab group decreased from 24.58±2.47 mmHg preoperatively to 14.40±2.69 mmHg 3 months postoperatively(P<0.01);there was no significant difference in intraocular pressure between the two groups at 3 months postoperatively.The range of PAS in Phaco+GSL group and Phaco+Trab group decreased significantly after operation;there was no significant difference between the two groups before operation;the range of PAS in Phaco+GSL group was significantly smaller than that in Phaco+Trab group(P<0.01).The anterior chamber depth(ACD),angle opening distance at 500?m(AOD500),trabecular-ciliary process distance(TCPD)and trabecular-iris angle(TIA)were significantly increased in Phaco+GSL group and Phaco+Trab group after operation,and there were no significant differences in ACD,AOD500,TCPD and TIA before operation between the two groups.There was no significant difference in ACD after operation;AOD500,TCPD and TIA in Phaco+GSL group were significantly higher than those in Phaco+Trab group.There was no significant change in the parameters of optic disc in Phaco+GSL group and Phaco+Trab group before and after operation.Mean deviation(MD)was significantly improved in Phaco+GSL group and Phaco+Trab group.The incidence of complications was 10.53% in Phaco+GSL group and 23.3% in Phaco+Trab group.The incidence of complications in Phaco+GSL group was lower than that in Phaco+Trab group.Conclusions: Phaco+GSL can be used in early PACG with cataract.GSL assisted by gonioscopy is simple and feasible,which can separate the angle accurately,safely and effectively,promote the outflow of aqueous humor through trabecular meshwork,and reduce intraocular pressure;Phaco+Trab can be used in patients with cataract complicated by PAG whose intraocular pressure can not be controlled during acute attack and whose PAS range is more than 180 degrees after attack or in advanced or late stage.