Phacoemulsification and goniosynechialysis in the management of unresponsive primary angle closure.
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.
Harasymowycz
Paul J
PJ
Department of Ophthalmology, Université de Montréal, Montréal, Québec, Canada. pharasymowycz@sympatico.ca
Papamatheakis
Demosthenes G
DG
Ahmed
Iqbal
I
Assalian
Alfred
A
Lesk
Mark
M
Al-Zafiri
Yousif
Y
Kranemann
Christoph
C
Hutnik
Cindy
C
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