Surgical outcome and safety of peripheral iridectomy plus goniosynechialysis and goniotomy in the treatment of advanced primary angle-closure glaucoma
Lin Fengbin, Lu Ping, Song Yunhe, Gao Xinbo, Zhang Yingzhe, Nie Xin, Peng Yuying, Li Xiaoyan, Zhu Xiaomin, Zhang Hengli, Zhang Yi, Xie Lin, Tang Guangxian, Tang Li, Fan Sujie, Zhang Xiulan
Abstract
ObjectiveTo evaluate the preliminary effectiveness and safety of surgical peripheral iridectomy (SPI) combined with goniosynechilysis (GSL) and goniotomy (GT) in the treatment of advanced primary angle-closure glaucoma (PACG).
MethodsA multicenter observational case series study was performed.Thirty-five eyes of 27 patients with advanced PACG, who underwent SPI+ GSL+ GT with a follow-up of at least 6 months, were included from August 2021 to January 2022 at Zhongshan Ophthalmic Center, Handan City Eye Hospital, Shijiazhuang People's Hospital, West China Hospital of Sichuan University, and the Third Affiliated Hospital of Chongqing Medical University.The mean follow-up time was 9(7, 10) months.Pre- and post-operative best corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured with an ETDRS chart and a Goldmann applanation tonometer, respectively.The number of anti-glaucoma medications applied before and after surgery was recorded, and the complications after surgery were analyzed.Success rate of surgery was calculated.Complete surgical success was defined as an IOP of 5-18 mmHg (1 mmHg=0.133 kPa) and 20% reduction from baseline without anti-glaucoma medication or reoperation.Qualified success was defined as achieving criterion of complete success under anti-glaucoma medications.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Zhongshan Ophthalmic Center, Sun Yat-sen University (No.2021KYPJ177). Written informed consent was obtained from each subject.
ResultsThe mean preoperative IOP was (30.83±8.87)mmHg, which was significantly decreased to (15.69±3.70)mmHg at 6 months after the surgery (t=8.588, P<0.001), with a 44.00% (34.78%, 60.00%) decline of 13.00(8.00, 21.00)mmHg.The median number of anti-glaucoma medications was significantly reduced from 2(0, 3) preoperatively to 0 (0, 1) postoperatively (Z=-3.659, P<0.001). The mean preoperative and postoperative 6-month BCVA were 0.80(0.63, 1.00) and 0.80(0.60, 1.00), respectively, showing no significant difference (Z=-0.283, P=0.777). Complete surgical success rate was 62.86%(22/35), and the qualified success rate was 91.43%(32/35). Surgical complications mainly included hyphema (6/35), IOP spike (3/35), and shallow anterior chamber (4/35). There was no vision-threatening complication.
ConclusionsSPI+ GSL+ GT is preliminarily effective and safe in the treatment of advanced PACG, which provides a new option for PACG.
Key words:
Glaucoma, angle-closure; Surgery; Multicenter study; Goniotomy; Goniosynechialysis; Peripheral iridectomy; Effectiveness; Safety
Contributor Information
Lin Fengbin
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
Lu Ping
Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China
Song Yunhe
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
Gao Xinbo
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
Zhang Yingzhe
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
Nie Xin
Department of Ophthalmology, People's Hospital of Chongqing, Chongqing 401120, China
Peng Yuying
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
Li Xiaoyan
Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China
Zhu Xiaomin
Department of Ophthalmology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
Zhang Hengli
Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang 050000, China
Zhang Yi
Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, China
Xie Lin
Department of Ophthalmology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
Tang Guangxian
Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang 050000, China
Tang Li
Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, China
Fan Sujie
Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China
Zhang Xiulan
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
