One-Year Outcomes of Phacoemulsification Combined with Trabecular Micro-Bypass Stent Implantation and Goniosynechialysis in Primary Angle Closure Glaucoma

Background/Objectives: Trabecular micro-bypass (iStent) implantation has been shown to effectively reduce intraocular pressure (IOP) and medication burden in open-angle glaucoma. However, its efficacy in primary angle closure glaucoma (PACG) remains unclear. We conducted this study to evaluate the one-year clinical outcomes of phacoemulsification combined with goniosynechialysis and iStent implantation (Phaco-GSL-iStent) in Korean patients with PACG. Methods: This retrospective study included 65 PACG eyes that underwent Phaco-GSL-iStent with follow-up of ≥12 months. Postoperative changes in mean IOP and glaucoma medications were assessed through postoperative 12 months. Predictors of postoperative changes in IOP and glaucoma medications were also evaluated. Results: Mean IOP significantly decreased from 18.3 ± 0.4 to 13.8 ± 0.3 mmHg at postoperative 12 months (p < 0.001). Mean number of glaucoma medications showed a statistically significant but small decrease from 2.85 ± 0.15 to 2.44 ± 0.13 at 12 months (p = 0.008). The 12-month cumulative qualified success rate was 86.2%. In multivariable analysis, IOP reduction at postoperative 12 months was positively associated with preoperative IOP (B = 0.707, p < 0.001). IOP spikes (defined as an increase of 5 mmHg or more from the baseline) were observed in two eyes (3.1%). Conclusions: These one-year outcomes suggest that Phaco-GSL-iStent can be an effective option to lower IOP in patients with PACG. However, the reduction in glaucoma medication use was limited in this study sample.