Single-pass four-throw pupilloplasty and phacoemulsification and intraocular lens implantation for acute angle-closure glaucoma

This prospective study aimed to assess the efficacy and safety of single-pass four-throw pupilloplasty combined with phacoemulsification and intraocular lens implantation in patients with acute angle-closure glaucoma who experienced their first acute attack and were unable to recover their pupils with medication and/or laser. Swept-source anterior segment optical coherence tomography was performed to measure anterior chamber angle parameters. Efficacy indicators included the intraocular pressure (IOP) and degree of decrease, changes in anterior chamber parameters, medication dosage, and success rate. Safety indicators included best corrected visual acuity, corneal endothelial cell examination and incidence of complications. The mean postoperative follow-up time was 12.80 ± 4.47 months. The mean highest IOP was 51.97 ± 5.87 mmHg (range 36–61 mmHg), the mean preoperative IOP was 37.85 ± 13.14 mmHg (range 12–61 mmHg); mean postoperative IOP was lower than that before. The mean preoperative LogMAR visual acuity was 0.75 ± 0.27 and it improved 1 year postoperatively (0.2 ± 0.08; p < 0.05). The mean number of IOP-lowering drugs was lower after surgery. The number of corneal endothelial cells before and after surgery was comparable, while the mean pupil diameter was smaller after surgery. The mean central anterior chamber depth and volume were greater after surgery. The mean angle opening distance and trabecular iris angle at 500 μm were significantly larger postoperatively. At 1-year postoperatively, the absolute success rate was 86.36%, the qualified success rate was 90.91%. Single-pass four-throw pupilloplasty combined with phacoemulsification and intraocular lens implantation is effective and safe for acute angle-closure glaucoma.