Abstract
Purpose :
To evaluate the efficacy and safety of phacoemulsification combined with different glaucoma surgery strategies in nanophthalmos secondary to angle closure glaucoma (NSACG)
Methods :
This retrospective interventional case series study collected medical records of patients diagnosed with NSACG with peripheral anterior synechiae (PAS) ≥180° between December 2011 and June 2021 at Beijing Tongren Hospital, Beijing, China. All the participants were further divided into 2 groups based on the AL and the surgical interventional procedures. Group 1 is defined as NSACG patients with an AL<20mm and ≥ 17.0mm underwent PEI+VGP+PPV (PVP) with Trabeculectomy (Trab) or Endoscopic photocoagulation (ECP). Group 2 is defined as NSACG patients with an AL <17mm, and underwent PEI+VGP+PPV+ Trab +Sclerectomy (PVPTS). The primary outcome is the proportion of patients with IOP ≤21 mmHg with or without ocular hypotensive medication OR those with a ≥ 20% reduction in IOP from baseline.
Results :
31 eyes of 22 patients were enrolled in our study with a mean follow-up period of 50.2±26.2 months. The mean age was 39.59±11.59 years, and the mean AL was 17.21±1.44mm. Among them, 13 eyes of 7 patients and 18 eyes of 15 patients were divided into Group 1 and Group 2, respectively. Compared to group 1 with longer AL, participants with extremely short AL tend to have worse PVA and BCVA (P=0.020 and P=0.026, respectively), more IOP-lowering medications (P=0.007), and shorter follow-up times (P=0.004). PVP combined with Trab or ECP can significantly reduce IOP (P<0.001) and the number of IOP-lowering medications (P=0.034) in NSACG patients with AL <20mm and ≥ 17.0mm, with 92.3% eyes had IOP drop rate≥20% and 69.2% eyes had IOP controlled under 21mmHg. For NSACG patients with extremely short AL <17mm, PVPTS can also significantly reduce IOP (P<0.001), and the number of IOP-lowering medications (P =0.007) with 94.4% of eyes had IOP drop rate≥20% and 77.8% of eyes achieved IOP controlled. There is no eye occurred postoperative malignant glaucoma in either group.
Conclusions :
PVP combined with Trab or ECP and PVPTS are two effective and safe surgical intervention strategies for patients with NSACG. Surgeries applied using the new criteria can generally achieve better IOP control outcomes with lower complication rates.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.