Phacoemulsification and Visco-synechiolysis With or Without Trabeculectomy Following Initial Management of Acute Primary Angle Closure: A Comparative Study

TL;DR

This study compares eye treatments for patients with recent acute angle closure, finding that adding trabeculectomy may lower pressure but not improve vision more than other procedures.

Contribution

The study evaluates the necessity of trabeculectomy in managing eyes with acute primary angle closure and cataracts.

Findings

Both PV and PVT groups showed significant improvement in BCVA, reduced IOP, and increased Shaffer grading scores.

PVT group had significantly lower IOP at six months compared to the PV group.

No serious complications were observed in any groups during follow-ups.

Abstract

To assess the effects of phacoemulsification, visco-synechiolysis, and trabeculectomy on eyes with a recent history of acute primary angle closure (APAC).

In this prospective nonrandomized study, we enrolled patients with cataracts, peripheral anterior synechiae (PAS), and a history of APAC attack managed with medications and laser peripheral iridotomy (LPI) within the past six weeks. Patients without signs of glaucomatous optic neuropathy (GON) underwent phacoemulsification and visco-synechiolysis (PV group). Trabeculectomy was added to this procedure for cases with signs of underlying chronic GON (PVT group). We evaluated best-corrected visual acuity (BCVA), intraocular pressure (IOP), angle opening, PAS extension, and adverse events at baseline and six months postoperatively.

The PV and PVT groups comprised 8 and 12 eyes, respectively. At month six, both groups showed significant improvement in BCVA, reduced IOP, and increased Shaffer grading scores compared to baseline (all Ps
<
0.05). Extensive PAS (
≥
180º) significantly decreased at month six in both the PV (P = 0.008) and PVT (P = 0.002) groups compared to baseline. However, its prevalence did not significantly differ between the two groups at baseline (P = 0.288) or six months after surgery (P = 0.881). At month six, IOP was significantly lower in the PVT group than the PV group (10.83
±
1.40 vs 13.63
±
2.07 mmHg, P = 0.002). Nevertheless, BCVA and Shaffer grading scores were not different between the two groups at this time point (P = 0.120, and P = 0.891, respectively). No serious complications were observed in any groups during the follow-ups.

Patients with cataracts and a recent history of APAC without underlying chronic glaucoma may not receive additional trabeculectomy alongside lens extraction and synechiolysis.