Predictive Factors for Ciliary Block after Cataract and Goniosynechialysis Surgery in Primary Angle-Closure Disease

PURPOSE: To identify predictive factors for ciliary block (CB) following combined phacoemulsification, intraocular lens implantation, and goniosynechialysis (P+I+GSL) in patients with primary angle-closure (PAC) and primary angle-closure glaucoma (PACG). DESIGN: A multicenter retrospective study. PARTICIPANTS: This study analyzed 66 eyes from 66 patients who underwent P+I +GSL between February 2022 and December 2024. Patients were categorized into 2 groups: those who developed CB (n = 33) and those who did not (n = 33). All participants were Chinese. METHODS: Preoperative biometric parameters obtained from ultrasound biomicroscopy and IOLMaster, along with intraoperative data, were analyzed. Univariable and multivariable logistic regression analyses were conducted to identify risk factors for CB. RESULTS: Compared to the non-CB group, patients who developed CB had shorter axial length (AL), narrower anterior chamber width (ACW), and thinner lenses (lens thickness [LT]) (P < 0.05) preoperatively. Multivariable analysis identified reduced ACW (odds ratio = 0.049, P < 0.05), decreased LT (odds ratio = 0.007, P < 0.05), and lack of preoperative mannitol administration (odds ratio = 0.025, P < 0.05) as significant predictors of CB. The optimal cutoff values for predicting CB were 11.72 mm for ACW and 4.84 mm for LT, with area under the curve values of 0.861 and 0.863, respectively. CONCLUSIONS: Shorter AL, narrow ACW, thin lenses, and lack of preoperative mannitol administration are significant risk factors for CB following P+I+GSL in PAC and PACG patients. These findings highlight the importance of preoperative assessment of ACW and LT, along with the use of mannitol, which may help reduce the incidence of CB in high-risk patients. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.