Comparative Evaluation of Phacoemulsification with Goniosynechialysis and Phacoemulsification with Viscogonioplasty in Angle-Closure: A Randomized Clinical Trial

Objective: To compare the effects of phacoemulsification with goniosynechialysis (GSL) versus viscogonioplasty (VGP) on intraocular pressure (IOP) reduction and medication use in angle-closure patients. Materials and Methods: This randomized controlled trial at Sisaket Hospital, Thailand, from November 2021 to May 2024, enrolled patients with angle-closure and cataracts. Group 1 underwent phacoemulsification with GSL, and Group 2 with VGP. Visual acuity, IOP, and medication use were assessed before surgery, then at 1 week, 1 month, 3 months, and 6 months post-surgery. Results: 58 eyes were included: 30 in Group 1 and 28 in Group 2. The average age was 67.16±9.65 years in Group 1 and 67.78±7.38 years in Group 2 (P=0.79). Baseline IOP was 24.31±12.34 mmHg in Group 1 and 24.92±12.50 mmHg in Group 2 (P=0.85). After 6 months, IOP decreased to 12.84±2.88 mmHg in Group 1 and 13.62±4.28 mmHg in Group 2 (P=0.40). Glaucoma medications decreased from 3.47±0.94 to 1.93±1.20 in Group 1 and from 3.54±0.58 to 1.46±1.37 in Group 2 (P=0.17). Hazard ratio: 4.29 (P=0.066, 95% CI: 0.91–20.18). Conclusion: Both Phaco-GSL and Phaco-VGP significantly reduce IOP, with no significant difference in efficacy. Phaco-GSL may sustain IOP reduction longer in extensive PAS cases. However, the short follow-up period and lack of postoperative gonioscopy are limitations. Longer-term studies with larger sample sizes are needed to confirm these results.