title: Phacoemulsification and goniosynechialysis in the management of unresponsive primary angle closure.
abstract: OBJECTIVE
  To evaluate the effectiveness of phacoemulsification and goniosynechialysis (PEGS) in managing acute and subacute primary angle closure unresponsive to conventional therapy.
  
  
  METHODS
  Retrospective series of patients of six glaucoma-trained surgeons with primary angle closure that did not respond to medical management, Nd:YAG laser peripheral iridotomy, or argon laser peripheral iridoplasty.
  
  
  RESULTS
  A total of twenty-one patients with an average age of 65.6 years were included. Underlying mechanism of angle closure included pupillary block (n = 18) and plateau iris (n = 3). Average intraocular pressure (IOP) immediately prior to PEGS was 40.7 mm Hg, and mean follow-up time after PEGS was 11.7 months. PEGS decreased mean IOP by 25 mm Hg (62%), and mean number of medications from 3.8 pre-surgery to 1.7 post-surgery (55%). Mean LogMar visual acuity improved after PEGS, from 0.64 to 0.44 (Paired t test t = 4.120 P = 0.001). Subsequent trabeculectomy was necessary in one case (5%).
  
  
  CONCLUSIONS
  Phacoemulsification with goniosynechialysis may be an effective treatment option for primary angle closure unresponsive to conventional therapy.
authors.affiliation: Department of Ophthalmology, Université de Montréal, Montréal, Québec, Canada. pharasymowycz@sympatico.ca
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Harasymowycz
authors.forename: Demosthenes G
authors.initials: DG
authors.lastname: Papamatheakis
authors.forename: Iqbal
authors.initials: I
authors.lastname: Ahmed
authors.forename: Alfred
authors.initials: A
authors.lastname: Assalian
authors.forename: Mark
authors.initials: M
authors.lastname: Lesk
authors.forename: Yousif
authors.initials: Y
authors.lastname: Al-Zafiri
authors.forename: Christoph
authors.initials: C
authors.lastname: Kranemann
authors.forename: Cindy
authors.initials: C
authors.lastname: Hutnik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D019654:Lens Implantation, Intraocular / Q000379:methods; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D012189:Retrospective Studies; D014129:Trabecular Meshwork / Q000601:surgery*; D016896:Treatment Outcome; D014792:Visual Acuity