- Design
- Multicentre prospective observational study
- Population
- 70 eyes with advanced primary angle-closure glaucoma without cataract
- Primary outcome
- IOP, medicines, success, complications at 36 months
- Effect
- IOP 29.4 to 16.4 mmHg; qualified success 84.3%
This multicentre prospective observational study followed 70 eyes of 58 patients with advanced primary angle-closure glaucoma without cataract for three years after combined surgical peripheral iridectomy, goniosynechialysis and goniotomy.
Mean pressure fell from 29.4 to 16.4 mmHg (about 41%), and medicines from 2.0 to 0.7. Complete success was 54% and qualified success 84% at three years. Visual fields were stable. Acuity worsened slightly, with 21% losing two or more lines, attributed to cataract progression; ten eyes needed cataract surgery and eleven had persistent synechiae. No vision-threatening complications were reported.
Angle closure is common in India, and many patients present late. This approach avoids a bleb, but there was no comparison group, so it cannot be ranked against trabeculectomy or lens extraction. Cataract progression is a real cost in phakic eyes.
- Consider combined angle surgery for advanced angle closure in clear-lens eyes where a bleb is undesirable.
- Warn patients that cataract may progress and need surgery within a few years.
- Monitor for persistent synechiae and pressure rise on gonioscopy at each visit.
- Weigh lens extraction as an alternative where the lens is contributing to closure.
Why it matters
It offers a bleb-free option for a common Indian presentation, though not yet against a comparator.
Don't overread it
A single-arm observational series; it cannot show this approach is better than standard surgery.
The statistics, in plain English
Qualified success allows drops; complete success does not. Without a control group, the pressure fall includes regression to the mean from high baseline readings.
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