title: Long-term efficacy of goniosynechialysis combined with phacoemulsification for primary angle closure.
abstract: OBJECTIVE
  To evaluate long-term efficacy of goniosynechialysis (GSL) combined with phacoemulsification and intraocular lens implantation (phaco-GSL) for primary angle closure or primary angle-closure glaucoma (PAC/PACG) and to analyze risk factors for surgical outcomes.
  
  
  METHODS
  We reviewed medical records of 109 eyes of 109 patients (mean [± SD] age 70 ± 9.4 years) who underwent phaco-GSL as primary treatment of PAC/PACG at five institutions. All eyes had a preoperative intraocular pressure (IOP) of ≥ 21 mmHg with or without medications. Surgical failure was defined as: (1) condition A: persistent IOP values of ≥ 21 mmHg, or (2) condition B: IOP values of ≥ 18 mmHg, with or without topical ocular medication, at two consecutive follow-up visits, or additional operations needed. Risk factors for surgical failure were analyzed via Cox proportional hazards model.
  
  
  RESULTS
  Mean follow-up was 40.0 months (range, 1 to 139 months). Probabilities of treatment success at 1 and 3 years after phaco-GSL were 85.9 % and 85.9 % (condition A) and 66.2 % and 61.0 % (condition B) respectively. Via multivariable analysis, we identified risk factors for surgical failure to be younger age (relative risk [RR] = 0.93/year, P = 0.0333) and absence of postoperative laser peripheral iridoplasty (LPI) (P = 0.0359) for condition A, and younger age (RR = 0.94/year, P = 0.0035), lower preoperative IOP (RR = 0.93/mm Hg, P = 0.0131), and absence of postoperative LPI (RR = 2.34, P = 0.0228) for condition B.
  
  
  CONCLUSIONS
  The outcome of phaco-GSL for PAC/PACG may depend on age, preoperative IOP, and postoperative LPI.
authors: Department of Ophthalmology and Visual Science, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Japan.
authors: Takanori
authors: T
authors: Kameda
authors: Toshihiro
authors: T
authors: Inoue
authors: Masaru
authors: M
authors: Inatani
authors: Hidenobu
authors: H
authors: Tanihara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000869:Anterior Eye Segment / Q000601:surgery*; D005128:Eye Diseases / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015812:Glaucoma, Angle-Closure / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D000267:Tissue Adhesions / Q000601:surgery; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology