A comparative evaluation of phacoemulsification with goniotomy versus trabeculectomy in patients with young onset primary angle closure glaucoma (YO PACG)

Title : A comparative evaluation of phacoemulsification with goniotomy versus trabeculectomy in patients with young onset primary angle closure glaucoma (YO PACG)

Abstract:

Introduction: The etiology of angle closure in young individuals differs from the older population and is typically associated with structural/developmental ocular anomalies rather than relative pupillary block. YO-PACG being a rare entity, there is paucity of literature regarding the surgery of choice for management of these eyes. Current Surgical treatment is fraught with complications like malignant glaucoma, as these patients often have high risk features like crowded anterior chambers, uveal effusions, and plateau iris. Hence, safer alternatives for the benefit of patients are the need of the hour.

Aims and Objectives: In this study, we evaluate the efficacy of Phacoemulsification with Goniotomy (PG) in young onset PACG (YO-PACG) and compared it with trabeculectomy, the current standard of surgical management in terms of post operative IOP control, need for post operative IOP lowering medications, post operative complications.

Materials and Methods: In this retrospective comparative study, data of 50 eyes of YO-PACG who fulfilled inclusion criteria and had undergone surgical intervention for IOP control were recruited. 25 of them had undergone Phaco-Goniotomy (Group 1) and 25 had underwent Trabeculectomy (Group 2). Their baseline data and postsurgical outcomes assessed at 1, 3, 6 and 12 months in terms of IOP control, need for IOP lowering medications, post-operative complications, and need for a repeat surgical intervention were recorded.

Results: 25 eyes were recruited for each group. A significant IOP reduction was noted in both the groups, dropping from 40.08 ± 9.8 mmHg and 39.68  ± 7.52 mmHg to 14 ± 4.34 mmHg and 14.6 ± 3.18 mmHg with PG(Group 1) and trabeculectomy(Group 2), respectively (p<0.001). A significant reduction in need for medications was also noted, reducing from 3 and 4 to 1 and 0 in Group 1 and Group 2 respectively (p<0.001). The postoperative IOP and medications needed at the end of 12 months was similar in both the groups (p=0.73 and p=0.94 respectively). 84 % eyes achieved success in Phacoemulsification with goniotomy group versus 72% in trabeculectomy group (p=0.76).The incidence of complications during 12 months follow up period was 12% and 24% for phacoemulsification with goniotomy versus trabeculectomy respectively (p=0.23). 36 % eyes achieved absolute success in Phacoemulsification with Goniotomy group versus 60 % in trabeculectomy group (p=0.36).

Conclusion: Phaco-goniotomy was non-inferior to trabeculectomy in terms of IOP control and need for medications in patients with YO-PACG. Trabeculectomy, however, showed a much higher incidence of complications.

Biography:

Dr Prannya Arora, born and brought up in the Heart and Capital of India , New Delhi, Pursued her MBBS at Lady Hardinge Medical College , New Delhi and is currently a Junior Resident Doctor at Dr Rajendra Prasad Centre for Ophthalmic Sciences , AIIMS New Delhi with a focused academic and clinical interest in ophthalmology. She is engaged in patient care, surgical assistance, and evidence-based clinical practice, with particular interest in Cataract, Glaucoma, Retinal disorders and Vitreoretinal surgery. She actively participates in academic activities, research discussions, and conference presentations. Outside of clinical work, she values physical fitness, mindful nutrition, and personal discipline, which she believes are essential for sustaining excellence in medicine. She is committed to lifelong learning, ethical medical practice, and continuous self-improvement, and aspires to pursue advanced subspecialty training while contributing meaningfully to ophthalmic research and patient care.