Efficacy and safety of primary customized phacoemulsification combined with goniosynechialysis for refractory acute primary angle closure

PurposeTo assess the safety, efficacy, and long-term clinical outcomes of primary customized phacoemulsification (phaco) combined with goniosynechialysis (GSL; phaco-GSL) in refractory acute primary angle closure (APAC) eyes with uncontrolled high intraocular pressure (IOP).MethodsThis retrospective case series comprised 51 eyes of 42 consecutive patients with refractory APAC and high IOP who were treated using primary customized phaco-GSL at 3 hospitals in China, from 2014 to 2021. Preoperative and postoperative IOP, corrected distant visual acuity (CDVA), corneal endothelial cell density (CECD), intraoperative and postoperative complications were recorded. The safety, efficacy and subsequent long-term clinical outcomes were analyzed.ResultsThe mean CDVA (LogMAR) was improved from 1.67 & PLUSMN; 0.94 preoperatively to 0.23 & PLUSMN; 0.26 postoperatively (P < 0.001). Preoperative CECD was 2309.39 & PLUSMN; 541.03 cells/mm(2) in 33 eyes and inaccessible in 18 eyes due to severe corneal edema; at the final follow-up, the mean CECD of all patients was 1823.50 & PLUSMN; 533.40 cells/mm(2) (P < 0.001). The mean IOP decreased from 48.51 & PLUSMN; 6.25 mmHg preoperatively to 15.66 & PLUSMN; 2.27 mmHg at the final follow-up (P < 0.001). Among 51 eyes, additional customized procedures performed were corneal indentation in 42 eyes, epithelial debridement in 9 eyes, giant epithelial bullae view in 4 eyes, pars-plana fluid aspiration in 3 eyes, and secondary intraocular lens implantation in 7 eyes. The IOP of all eyes was well controlled eventually and 47 eyes (92.16%) were successfully treated by phaco-GSL alone. No significant intraoperative or postoperative complications were observed.ConclusionsPrimary customized phaco-GSL is a safe and effective surgical management strategy for patients with refractory APAC and high IOP.