Lensectomy with anterior vitrectomy plus goniosynechialysis followed by iris-claw intraocular-lens implantation in microspherophakia-induced glaucoma

Purpose This study aims to investigate the effect of lensectomy with anterior vitrectomy plus goniosynechialysis followed by a secondary iris-claw intraocular-lens implantation on intraocular pressure (IOP) and visual acuity in pediatric patients with microspherophakia-associated angle-closure glaucoma. Patients and methods A prospective randomized interventional case-series surgical study included 24 eyes of 12 patients aged from 6 to16 years with angle-closure glaucoma. Patients initially underwent lensectomy plus anterior vitrectomy and goniosynechialysis in a primary session followed later by secondary iris-claw implantation. The main outcome measure was IOP control and stability and the secondary outcome measure was visual acuity. Results IOP decreased from 25±2.59 mmHg preoperatively to 13.21±1.77, 14.71±2.33, 16.17±3.25, 16.13±3.55, 15.63±1.17, 15.67±1.17, 15.67±1.17, 15.71±1.23, 15.71±1.23, 5.71±1.23, 15.71±1.23, and 15.71±1.23 at 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months postoperatively. IOP was controlled with complete success in 62.5% of cases and qualified success in 29.2%, while 8.3% became controlled with further glaucoma surgery. Anterior-chamber depth increased from 1.56±0.7 preoperatively to 3.33±0.20 postoperatively and remained stable over the next 5 years (P˂0.001). Visual acuity significantly improved from 0.79±0.1 to 0.88±0.8 (P˂0.001). Refractive error significantly decreased from −16 D preoperatively to −0.5 D postoperatively (P˂0.01). Antiglaucoma treatment decreased significantly as 62.55% of patients stopped receiving antiglaucoma treatment postoperatively (P˂0.001). Conclusion Lensectomy with anterior vitrectomy and goniosynechialysis followed by secondary iris-claw intraocular-lens implantation is effective in the control of angle-closure glaucoma secondary to microspherophakia and results in significant improvement in visual acuity.