Phacoemulsification Versus Combined Phacoemulsification and Viscogonioplasty in Primary Angle-Closure Glaucoma: A Randomized Clinical Trial.
OBJECTIVE
To compare the effect of phacoemulsification (Phaco) versus combined phacoemulsification and viscogonioplasty (Phaco-VGP) on long-term intraocular pressure (IOP) in primary angle-closure glaucoma (PACG).


METHODS
In this prospective randomized clinical trial, 92 eyes of 82 patients with PACG and coexisting cataract were randomized to undergo Phaco alone (46 eyes) or Phaco-VGP (45 eyes) and completed the trial. Anterior segment optical coherence tomography was performed preoperatively and at 1 year after surgery. Main outcome measures were IOP and the number of IOP-lowering medications.


RESULTS
Phaco alone reduced the mean IOP from a preoperative level of 22.3±6.3 to 14.0±3.7 mm Hg at 12 months after surgery (P<0.001). Phaco-VGP reduced the mean IOP from a preoperative level of 23.3±7.3 to 14.5±2.5 mm Hg (P<0.001). There were no statistically significant differences between the 2 groups in IOP and number of medications at all follow-up times. Trabecular-iris space-area measured by anterior segment optical coherence tomography increased significantly after Phaco alone and Phaco-VGP. The amount of the increase was higher in the Phaco-VGP. Although peripheral anterior synechiae (PAS) extent decreased significantly by Phaco alone, Phaco-VGP resulted in significantly greater reduction in PAS extent (P=0.004). The only variables that predicted change in IOP in the whole group were preoperative IOP (β=-0.891, P<0.001) and female sex (β=2.754, P=0.02).


CONCLUSIONS
Phaco alone and Phaco-VGP resulted in widening of the drainage angle, reduction of IOP, and PAS extent in PACG eyes. Phaco-VGP resulted in significantly more reduction of PAS and more opening of angle. However, it seems that additional VGP has no significant effect on long-term IOP.
*Farabi Eye Research Center, Tehran University of Medical Science, Tehran, Iran †Department of Ophthalmology, San Francisco School of Medicine, University of California, San Francisco, CA.
Sasan
S
Moghimi
Golshan
G
Latifi
Narges
N
ZandVakil
Massood
M
Mohammadi
Nassim
N
Khatibi
Reza
R
Soltani-Moghadam
Shan
S
Lin
D000368:Aged; D004311:Double-Blind Method; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000503:physiopathology / Q000601:surgery*; D006068:Gonioscopy; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007429:Intraocular Pressure / Q000502:physiology; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D011446:Prospective Studies; D041623:Tomography, Optical Coherence; D014065:Tonometry, Ocular; D014129:Trabecular Meshwork / Q000601:surgery*; D014130:Trabeculectomy / Q000379:methods*; D055675:Viscosupplements / Q000627:therapeutic use*
D055675:Viscosupplements; D006820:Hyaluronic Acid