Efficacy and Safety of Surgical Peripheral Iridectomy, Goniosynechialysis, and Goniotomy for Advanced Primary Angle Closure Glaucoma Without Cataract: 1-Year Results of a Multicenter Study-Reference-Cited by-同舟云学术

Efficacy and Safety of Surgical Peripheral Iridectomy, Goniosynechialysis, and Goniotomy for Advanced Primary Angle Closure Glaucoma Without Cataract: 1-Year Results of a Multicenter Study

Published:2024-05-24 Issue:9 Volume:33 Page:632-639
ISSN:1057-0829
Container-title:Journal of Glaucoma
language:en
Short-container-title:

Author:

Gao Xinbo¹,Lin Fengbin¹,Lu Ping²,Xie Lin³,Tang Li⁴,Zhu Xiaomin³,Zhang Yao⁴,Lv Aiguo²,Tang Guangxian⁵,Zhang Hengli⁵,Yan Xiaowei⁵,Song Yunhe¹,Xu Jiangang¹,Huang Jingjing¹,Zhang Yingzhe¹,Hu Kun¹,Peng Yuying¹,Wang Zhenyu¹,Li Xiaoyan²,Chen Weirong¹,Wang Ningli⁶,Barton Keith⁷,Park Ki Ho⁸,Aung Tin⁹,Weinreb Robert N.¹⁰,Lam Dennis S.C.¹¹,Fan Sujie²,Tham Clement C.¹²,Zhang Xiulan¹,

Affiliation:

1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou

2. Handan City Eye Hospital (The Third Hospital of Handan), Handan

3. Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing

4. Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province

5. Department of Ophthalmology, Shijiazhuang People’s Hospital, Hebei Province

6. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing

7. NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK

8. Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

9. Singapore Eye Research Institute, Singapore National Eye Center, Singapore

10. Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, and Shiley Eye Institute, University of California San Diego, CA

11. International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen

12. Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong Special Administrative Region, China

Abstract

Précis: The combination of surgical peripheral iridectomy, goniosynechialysis, and goniotomy is a safe and effective surgical approach for advanced primary angle closure glaucoma without cataract. Purpose: To evaluate the efficacy and safety of surgical peripheral iridectomy (SPI), goniosynechialysis (GSL), and goniotomy (GT) in advanced primary angle closure glaucoma (PACG) eyes without cataract. Patients and Methods: A prospective multicenter observational study was performed for patients who underwent combined SPI, GSL, and GT for advanced PACG without cataract. Patients were assessed before and after the operation. Complete success was defined as achieving intraocular pressure (IOP) between 6 and 18 mm Hg with at least a 20% reduction compared with baseline, without the use of ocular hypotensive medications or reoperation. Qualified success adopted the same criteria but allowed medication use. Factors associated with surgical success were analyzed using logistic regression. Results: A total of 61 eyes of 50 advanced PACGs were included. All participants completed 12 months of follow-up. Thirty-six eyes (59.0%) achieved complete success, and 56 eyes (91.8%) achieved qualified success. Preoperative and postsurgical at 12 months mean IOPs were 29.7±7.7 and 16.1±4.8 mm Hg, respectively. The average number of ocular hypotensive medications decreased from 1.9 to 0.9 over 12 months. The primary complications included IOP spike (n=9), hyphema (n=7), and shallow anterior chamber (n=3). Regression analysis indicated that older age (odds ratio [OR]=1.09; P=0.043) was positively associated with complete success, while a mixed angle closure mechanism (OR=0.17; P=0.036) reduced success rate. Conclusions: The combination of SPI, GSL, and GT is a safe and effective surgical approach for advanced PACG without cataract. It has great potential as a first-line treatment option for these patients.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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