The efficacy and safety of combined phacoemulsification, intraocular lens implantation, and limited goniosynechialysis, followed by diode laser peripheral iridoplasty, in the treatment of cataract and chronic angle-closure glaucoma

Abstract

Purpose: To report the efficacy and safety of combined phacoemulsification, intraocular lens implantation, and limited goniosynechialysis, followed by diode laser peripheral iridoplasty, in the treatment of cataract and chronic angle-closure glaucoma. Methods: Patients with chronic angle-closure glaucoma with total synechial angle closure and intraocular pressures higher than 21 mm Hg on maximally tolerated medications, and concurrent cataract, underwent phacoemulsification with posterior chamber intraocular lens implantation and goniosynechialysis followed by diode laser peripheral iridoplasty to the inferior half of the angle. Intraoperative complications, postoperative visual acuity, intraocular pressures, and complications were evaluated. Results: Seven eyes of seven patients received the operation, and the mean follow-up was 8.9 months (range, 2-16 months). The mean preoperative intraocular pressure was 33.0 ± 4.8 mm Hg. The mean postoperative intraocular pressure at most recent follow-up was 13.3 ± 2.9 mm Hg. The absolute success rate (intraocular pressure less than 21 mm Hg without medication) was 100%. The visual acuity of all eyes improved by more than two Snellen lines. Postoperative complications included intraocular pressure spike, hyphema, and transient corneal decompensation. Conclusion: It appears that phacoemulsification with intraocular lens implantation combined with inferior 180° goniosynechialysis followed by diode laser peripheral iridoplasty is an effective and safe surgical procedure for treating chronic angle-closure glaucoma with total synechial angle closure and cataract.