Comparison Of The Effects Of Phakoemulsification With IOL Alone Vs. Phakoemulsification With IOL And Goniosynechialysis On Outflow Facility In Patients With Primary Angle Closure Glaucoma: A Randomised Pilot Study

Abstract

 

Purpose:

 

A pilot study to compare the effects of cataract surgery alone versus cataract surgery and goniosynechialysis (GSL) on tonographic outflow facility and intraocular pressure (IOP) in subjects with primary angle closure with (PACG) and without glaucoma (PAC).

 

Methods:

 

Sixteen patients (17 eyes) with PAC/PACG were enrolled in this prospective comparative study (NCT00719290). Patients were randomised by using Excel random number generator and opaque sealed envelopes to phakoemulsification with intraocular lens implant (IOL) (n=7) or phakoemulsification with IOL and GSL (n=10). Patients were included if they had untreated IOP>21mmHg or were on IOP-lowering medications, had more than 180º long-standing peripheral anterior synachiae and had significant lens opacity. Success was defined 20% reduction in IOP at 3 month compared to baseline with less or equal number of medications. IOP was measured using Goldman applanation tonometry and electronic Schiotz tonography was used to measure the outflow facility (TOF) pre and postoperatively.

 

Results:

 

The mean age of the study population was 67.55±10.15 (mean±SD) years. Overall, a 32.29% reduction in IOP was observed (80% success rate) associated with a 55.5% increase in TOF. Patients in the phakoemulsification group had significantly lower preoperative IOP than the GSL group (p=0.02) but similar baseline TOF (p=0.37) and mean number of medications (p=0.47). In the GSL group, IOP decreased significantly from 27.20±7.0mmHg to 16.64±4.3mmHg (p=0.04) while TOF increased from 0.07±0.04µl/min/mmHg to 0.13±0.08µl/min/mmHg (p=0.09). In the phakoemulsification group, IOP decreased from 18.86±4.70mmHg to 13.66±1.52mmHg (p=0.10) and TOF increased from 0.11±0.08µl/min/mmHg to 0.12±0.02µl/min/mmHg (p=0.10). No statistically significant differences regarding IOP (p=0.24), TOF (p=0.90) and number of medications (p=0.31) were found between groups at 3 months follow-up.

 

Conclusions:

 

Phakoemulsification with GSL reduces significantly the IOP in patients with PACG, most likely by increasing the TOF. However, our results suggest GSL in long-standing PAS provide no additional benefit to phakoemulsification alone in the treatment of these patients.

 

Clinical Trial:

 

http://www.clinicaltrials.gov NCT00719290

 

Keywords: outflow: trabecular meshwork • cataract