# 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.

## Key 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.