Comparative efficacy of phacoemulsification combined with goniosynechialysis versus trabeculectomy for acute angle-closure glaucoma with cataract: a retrospective study
This retrospective study of 95 patients (109 eyes) with acute angle-closure glaucoma and cataract found that while phacoemulsification combined with trabeculectomy achieved greater intraocular pressure reduction, phacoemulsification combined with goniosynechialysis offered comparable visual and anatomical improvements with a significantly lower incidence of postoperative complications, suggesting it may be a safer alternative for selected patients.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
The human eye relies on a delicate balance of fluid to maintain its shape and function. This fluid, known as aqueous humor, constantly circulates through the front of the eye before draining out through a tiny mesh-like structure called the drainage angle. When this angle becomes blocked, the fluid builds up, pressure rises, and the optic nerve can be damaged, leading to a condition called glaucoma. In many cases, particularly among older adults, this blockage is triggered by the natural aging of the eye's lens. As the lens thickens and swells, it pushes forward, crowding the space at the front of the eye and sealing shut the drainage angle. This sudden closure causes a rapid and dangerous spike in eye pressure, a medical emergency known as acute angle-closure glaucoma. Because the thickened lens is often the root cause, surgeons frequently remove it along with replacing it with a clear artificial lens. However, when the eye is already under severe stress from glaucoma, doctors face a difficult choice: should they simply remove the lens and hope the drainage angle opens up on its own, or should they perform a more invasive procedure to create a new drainage pathway?
A team of researchers at the General Hospital of Northern Theater Command set out to answer this question by looking back at the medical records of nearly one hundred patients who had undergone surgery for this specific combination of conditions. They compared two different surgical strategies. The first approach involved removing the cloudy lens and performing a trabeculectomy, a traditional surgery where a surgeon creates a new opening in the eye wall to let fluid escape. The second approach involved removing the lens and performing a goniosynechialysis, a technique where the surgeon uses a special tool and fluid pressure to gently peel away the scar tissue that is blocking the natural drainage angle, without creating a new hole in the eye. The goal was to see which method offered the best balance of lowering eye pressure, restoring vision, and avoiding complications.
The study included 109 eyes from 95 patients who had been treated between 2015 and 2024. The researchers divided these patients into two groups based on which surgery they received. The first group, consisting of 64 eyes, underwent the combined lens removal and trabeculectomy. The second group, with 45 eyes, received the lens removal combined with the procedure to clear the natural drainage angle. Before the surgery, both groups had similar levels of eye pressure, vision, and the extent of the blockage in their drainage angles, ensuring a fair comparison. The team then tracked the patients closely over six months, measuring their eye pressure, vision clarity, and the depth of the front chamber of the eye at several intervals after the operation.
The results showed that both surgeries were effective at solving the immediate problem. In both groups, the eye pressure dropped significantly from preoperative levels, and the front chamber of the eye became deeper, which is a good sign that the blockage had been relieved. Vision also improved dramatically for everyone. However, when the researchers looked at the details, a clear difference emerged regarding the side effects. The group that underwent the trabeculectomy experienced a wider range of complications. Thirteen patients in this group developed low eye pressure, eight had swelling of the cornea, two experienced a separation of the inner layers of the eye, and one developed a severe inflammation of the white part of the eye. One patient even had to undergo a second surgery because the glaucoma returned. In contrast, the group that received the less invasive angle-clearing procedure had a much smoother recovery. Only three eyes in this group experienced corneal swelling, and there were no reports of low eye pressure, severe inflammation, or the need for repeat surgery.
While the traditional trabeculectomy did lower the eye pressure slightly more than the other method at every point measured after the surgery, the difference was small, and the pressure in both groups remained within a safe, normal range. The less invasive method actually allowed patients to see better just four days after the operation, likely because the surgery was quicker and caused less temporary irritation to the eye's surface. By the one-month mark, the procedure that cleared the natural drainage angle was significantly more successful at removing the scar tissue that had been blocking the angle, suggesting it addressed the root mechanical problem more directly.
The researchers concluded that while the traditional method of creating a new drainage hole is powerful, it carries a higher risk of serious side effects. The alternative approach, which focuses on clearing the natural drainage path, offers a safer profile with comparable long-term results for vision and pressure control. For patients facing this specific type of glaucoma combined with a cataract, the study suggests that the less invasive option is a strong candidate, particularly for those who wish to avoid the potential complications associated with creating a new drainage hole. The findings provide a clearer path for surgeons to choose the right tool for the job, prioritizing patient safety without sacrificing the effectiveness of the treatment.
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