Title : Effects of phacoemulsification, viscosynechiolysis, and trabeculectomy on recent cases with acute primary angle closure
Abstract:
Purpose: To investigate the differences in the effects of phacoemulsification, viscosynechiolysis, and Trabeculectomy on cases with a recent history of Acute Primary Angle Closure (APAC).
Methods: Patients with cataracts, Peripheral Anterior Synechia (PAS), and a history of APAC in the prior six weeks, managed with medications and laser peripheral iridotomy (LPI), were included. Initially, those without signs of glaucomatous optic neuropathy underwent phacoemulsification and viscosynechiolysis (i.e., the PV group), while cases with it had an additional Trabeculectomy (i.e., the PVT group). Then, the best-corrected visual acuity (BCVA), intraocular pressure (IOP), angle opening, PAS extension, and adverse events at baseline and six months after surgery were evaluated.
Results: The PV and PVT groups comprised 8 and 12 eyes, respectively. After six months, both groups experienced significant improvements in IOP, BCVA, and Shaffer grading scores (All p < 0.05). Even though the latter two were not different between the two groups (p = 0.120 for BCVA; p = 0.891 for the Shaffer grading score), IOP was significantly lower in the PVT group (10.83 ± 1.40 vs. 13.63 ± 2.07 mmHg, p = 0.002). Furthermore, extensive PAS (i.e., ≥ 180°) significantly decreased at month 6 in both groups (p = 0.008 for PV; p = 0.002 for PVT). However, both groups had similar frequencies of extensive PAS at baseline (p = 0.288) and six months after surgery (p = 0.881). In addition, no adverse events were noted in the groups during follow-up.
Conclusions: Combined phacoemulsification and viscosynechiolysis may yield similar outcomes in angle opening and extensive PAS reduction compared to an additional Trabeculectomy in patients with cataracts and a recent history of APAC.
Keywords: Acute Primary Angle Closure; Glaucoma; Phacoemulsification; Viscosynechiolysis; Trabeculectomy; Peripheral Anterior Synechiae.
