July 23, 2025Frontiers in Medicine1 citationsOpen Access

Comparison of efficacy and safety of combined phacoemulsification, goniosynechialysis and goniotomy with trabeculectomy in advanced primary angle-closure glaucoma: a retrospective observational study

WZWenzhe ZhangWuhan University of Technology PWPengyun WangChongqing University CWChen WangTongji University

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Abstract

Purpose: The study is a retrospective observational study. This study aimed to compare the intraocular pressure (IOP) lowering effect of phacoemulsification combined with intraocular lens implantation (PEI), Goniosynechialysis (GSL), and goniotomy (GT) vs. trabeculectomy (TRAB) in eyes with medically uncontrolled advanced primary angle-closure glaucoma (PACG) at a 12-month follow-up. Methods: Patients with medically uncontrolled advanced PACG with 360° peripheral anterior synechia (PAS) were included in this study. The patients were divided into two groups based on the surgical technique: PEI + GSL + GT and TRAB. Each patient completed a 12-month postoperative follow-up. Results: < 0.001), respectively. As for success rates, among the 43 eyes in the PEI + GSL + GT group, 35 eyes (81.40%) and 40 eyes (93.02%) achieved complete and qualified success with IOP ≤21 mmHg. In the TRAB group, out of 30 eyes, 25 eyes (83.33%) and 29 eyes (96.67%) achieved complete and qualified success with IOP ≤21 mmHg, respectively. Among the 43 eyes in the PEI + GSL + GT group, 33 eyes (76.74%) and 37 eyes (86.05%) achieved complete and satisfactory success with IOP ≤18 mmHg, respectively. While in the TRAB group, 24 eyes (80.00%) and 27 eyes (90.00%) achieved complete and qualified success, respectively, with IOP ≤18 mmHg. There was no significant difference in visual field (VF) between preoperative and postoperative periods in both groups. All eyes exhibited no serious postoperative complications that threatened vision. Conclusions: PEI + GSL + GT and TRAB demonstrated comparable efficacy in lowering IOP, reducing medications, and preserving VF in medically uncontrolled advanced PACG. Moreover, PEI + GSL + GT exhibited fewer complications, avoid bleb-related complications and may be a novel minimally invasive alternative for treating advanced PACG.

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