The extent of peripheral anterior synechiae and efficacy of combined phacoemulsification and goniosynechialysis in primary angle-closure glaucoma and cataracts: A multicenter prospective study

PURPOSE: To investigate the association between the preoperative extent of peripheral anterior synechiae (PAS) and the efficacy of combined phacoemulsification (PEI) and goniosynechialysis (GSL) in primary angle-closure glaucoma (PACG) with cataracts. DESIGN: Multicenter prospective study METHODS: Patients with PACG and cataracts undergoing PEI-GSL were recruited from five hospitals between November 1, 2022, and March 12, 2024. According to the extent of PAS, the patients were divided into three groups: PAS < 180°, 180°≤ PAS ≤ 270°, and 270°< PAS ≤ 360°. Intraocular pressure (IOP), the number of antiglaucoma medications, cumulative success rates, complications, and reoperations were analyzed. The relationship between chamber angle and IOP was also examined using anterior segment optical coherence tomography (AS-OCT). RESULTS: Of 232 patients who were enrolled for the surgical outcome analysis. The IOP and the number of antiglaucoma medications were significantly reduced in the three groups after surgery. At 12 months postoperatively, the IOP values were 13.8 ± 3.2 mmHg, 14.3 ± 3.0 mmHg, and 13.6 ± 2.8 mmHg (P > 0.05), and the number of antiglaucoma medications was 0.15 ± 0.66, 0.17 ± 0.50, and 0.04 ± 0.20 (P > 0.05) for the PAS < 180°, 180° ≤ PAS ≤ 270°, and 270°< PAS ≤ 360° groups, respectively. The complete success rates were 83.0 %, 77.1 %, and 84.8 % (P = 0.345), and the qualified success rates were 85.9 %, 87.6 %, and 91.0 % (P = 0.690), respectively. There were no significant differences in complications and reoperation among the three groups (P > 0.05). Furthermore, the change in IOP and the percentage change in IOP increased with the extent of PAS. The AS-OCT parameters were not associated with postoperative IOP (P > 0.05), but some were associated with the change in IOP and the percentage change in IOP. CONCLUSIONS: The success rate and complications of PEI-GSL in treating PACG and cataracts were independent of the baseline extent of PAS. The larger extent of baseline PAS achieved greater IOP reduction postoperatively, and the AS-OCT parameters were related to the change in IOP.