One-year outcomes of combined phacoemulsification and goniosynechialysis in primary angle-closure glaucoma with cataracts: a multicenter prospective study

BACKGROUND: This study aimed to observe the safety and effectiveness of combined phacoemulsification and goniosynechialysis (PEI-GSL) in patients with primary angle-closure glaucoma (PACG) and coexisting cataracts. METHODS: This multicenter prospective study enrolled 289 consecutive patients with PACG and cataracts who were treated using PEI-GSL between November 1, 2022 and March 12, 2024. All patients underwent comprehensive ocular evaluations at baseline, at 1 week, and at 1, 3, 6, and 12 months postoperatively. Complete success was defined as achieving an intraocular pressure (IOP) of 6-18 mmHg without antiglaucoma medications or reoperation. Qualified success was similarly defined but allowed antiglaucoma medications. RESULTS: Among patients with PACG, 237 (82.0%) of 289 completed a 12-month follow-up. The baseline IOP decreased from 22.9 ± 10.2 to 14.0 ± 3.1 mmHg at 12 months, and the number of antiglaucoma medications declined from 2.08 ± 1.23 to 0.14 ± 0.52. The complete and qualified success rates were 80.6% and 88.3%, respectively. Postoperative complications occurred in 49 (17.0%) patients; while 3 (1.0%) patients underwent yttrium-aluminum-garnet (YAG) laser capsulotomy and 6 (2.1%) required glaucoma surgery. Multivariate Cox regression analysis revealed that the anterior chamber depth (P = 0.044) and axial length (P = 0.050) were positively associated with qualified success. The complete and qualified success rates among patients with advanced PACG were 78.2% and 87.9%, respectively. CONCLUSION: We demonstrated that PEI-GSL is an effective and safe treatment for patients with PACG and coexisting cataracts, even in advanced stages.