Outcomes of combined lens extraction and goniosynechialysis in angle closure

Background The aim of this study was to assess the effect of goniosynechialysis on intraocular pressure and medication requirement in patients with angle closure. Design A retrospective chart review. Participants 51 eyes from 42 patients were included in the study. 17 had documented evidence of acute angle closure while 34 had chronic angle closure. Methods Examination of the medical records of patients with synechial primary angle closure who underwent combined phacoemulsification and goniosynechialysis from 2003–2011 at 3 centres. Main Outcome Measures Intraocular pressure and requirement for drops were the main outcome measures. Results Mean follow-up was 25.9 months for the acute group and 25.4 months for the chronic group. Mean preoperative intraocular pressure was 23.33 ± 14.41 mmHg on an average of 2.51 ± 1.3 medications. Mean postoperative intraocular pressure was lowered to 13.67 ± 2.41 (p ≤ 0.01) and medication usage was significantly lowered to 0.65 ± 0.87 (p ≤ 0.01). Subjects with documented acute symptomatic angle closure had higher preoperative intraocular pressure and a larger intraocular pressure fall post goniosynechialysis (from 30.41 mmHg ± 23 mmHg to 12.12 mmHg ± 2.32 mmHg) compared to those without such a documented episode (19.79 mmHg ± 4.37 mmHg to 14.44 mmHg ± 2.08 mmHg, p = 0.007). Both groups have similar postoperative need for glaucoma medication, 0.65 ± 0.93 vs 0.65 ± 0.85. Conclusions Combined phacoemulsififcation and goniosynechialysis reduces intraocular pressure, medication requirements and need for further surgery in subjects with angle closure. The procedure is more effective in eyes with a previously documented acute symptomatic presentation of angle closure.