Surgical management of medically uncontrolled synechial angle-closure Glaucoma: Lensectomy <i>with or without</i> Goniosynechialysis

PurposeTo investigate the efficacy of lensectomy (LE) and the role of additional goniosynechialysis (LE-GSL) in eyes with medically uncontrolled synechial angle-closure glaucoma (ACG).MethodsThe records of patients who underwent LE or LE-GSL for >180° synechial ACG were reviewed retrospectively. Three groups were formed based on intraoperative gonioscopy (IOG) findings following lensectomy and intraocular lens implantation: Group 1 (<i>n</i> = 39), eyes with total peripheral anterior synechiae (PAS) in which GSL was performed; Group 2 (<i>n</i> = 37), eyes with PAS ≥ 180° and <360° in which GSL was performed; and Group 3 (<i>n</i> = 35), eyes with PAS < 180° in which no GSL was performed.ResultsA total of 111 eyes of 98 patients (M/F: 46/52; mean age: 60.1 ± 11.01 years) were included in the study. Median postoperative follow-up time was 12.0 months. Median PAS extents in the three groups were 12, 6, and 0 clock hours (CH) on IOG, compared to 12, 10, and 7 CH before surgery. GSL was performed in Groups 1 and 2, with a median of 11 and 4 CH. Median IOP at the final visit was 14 mmHg in all three groups. Total success rates were 87%, 81%, and 97% in Groups 1, 2, and 3, respectively (<i>p</i> = 0.102).ConclusionThe present study identified discrete groups of patients who would benefit from LE alone versus needing further GSL in synechial ACG. When PAS was <180° on IOG, LE alone effectively reduced IOP; in eyes with extensive PAS, performing additional GSL yielded successful results, comparable to eyes undergoing LE alone.