Efficacy of Goniosynechialysis for Advanced Chronic Angle-Closure Glaucoma

Abstract

 

Purpose

 

To evaluate the intraocular pressure (IOP) lowering efficacy of goniosynechialysis (GSL) for chronic angle-closure glaucoma (CACG) using a simplified slit lamp technique in a prospective randomized, controlled study.

 

Methods

 

Patients with CACG was treated with either anterior chamber(AC) paracentesis-guided limited GSL under biomicroscope with a needle or anti-glaucoma medication after laser peripheral iridotomy (LPI). All patients underwent ophthalmologic examinations including measurement of VA, BCVA, and IOP, biomicroscopy; fundus examination; and gonioscopy followed by GSL in the surgical group and prescription of anti-glaucoma medication along with LPI in the control group. The post-treatment IOP was monitored in the follow-up visits. Statistics was done to compare the IOP-lowering efficacy between goniosynechialysis and LPI with anti-glaucoma medication.

 

Results

 

Forty-four patients (28 men, 14 women) were identified as having CACG and randomly divided into the surgical group and the control group. On admission, the average IOP was 27.1 ± 6.7 mmHg (range, 25-37) in the surgical group and 26.8± 7.4mmHg (range, 23-41) in the control group. No statistical difference was found between the initial IOP levels of these two groups. Six month after the treatment, the mean IOP in the surgcial group decreased to 16.3 ± 2.8 mmHg (range, 14-19) without anti-glaucoma medication. Meanwhile, the average IOP in the control group was 17.3 ± 2.4 mmHg (range, 13-20) without an average of 1.2 anti-glaucoma eydrops (range, 0-3). Both groups have a significant decrease in IOP after treatment. Nevertheless, the surgical group had statistically lower IOP and more decrease in IOP than that of the control group, identified with paired sample T test. AC bleeding was the most common complication of the AC paracentesis guided GSL, which occurred in 59.1% of the cases (13 /22) and was absorbed thin several days without special care.

 

Conclusions

 

GSL lowers the IOP significantly in patients with advanced CACG, though it may lead to mild AC bleeding.

 

 

Figure 1. A, A 26-gauge needle is inserted into the anterior chamber angle in front of the iris before peripheral anterior synechiae (PAS) dissection. B, The surgeon pushed the iris root backward to drag it down from the angle wall and trabecular meshwork surface. The trabecular meshwork is exposed after the dissection of the PAS.

 

Keywords: 462 clinical (human) or epidemiologic studies: outcomes/complications • 568 intraocular pressure