A three-part operation lowered pressure for three years in advanced angle closure, with cataract as the main late cost

Design

Multicentre prospective observational study, single-arm, 36-month follow-up

Population

70 eyes of 58 patients with advanced primary angle-closure glaucoma without cataract

Primary outcome

Intraocular pressure change, medication use, surgical success and complications

Effect

IOP 29.4 to 16.4 mmHg (40.7% reduction); complete success 54.3%, qualified success 84.3%

This multicentre prospective observational study followed 70 eyes (58 patients) with advanced primary angle-closure glaucoma and no cataract that underwent combined peripheral iridectomy, goniosynechialysis and goniotomy, and completed 36 months of follow-up.

Mean intraocular pressure fell from 29.4 mmHg to 16.4 mmHg (a 40.7% reduction, p < 0.001) and mean medication count from 2.0 to 0.7. Cumulative complete success was 54.3% and qualified success 84.3%. Median best-corrected acuity worsened slightly (logMAR 0.00 to 0.10) and 21.4% of eyes lost two or more Snellen lines, attributed to cataract progression; visual field mean deviation was stable. Cataract surgery was needed in ten eyes and persistent synechiae were found in eleven; no vision-threatening events were reported.

There was no comparison group, so it cannot be set against phacoemulsification-based approaches or trabeculectomy. It shows what this approach achieved in eyes that were phakic by selection, and suggests counselling that cataract is likely to follow.

• Mean intraocular pressure fell from 29.4 to 16.4 mmHg at 36 months.
• Complete success was 54.3%; qualified success (with medication) 84.3%.
• About one in five eyes lost two or more Snellen lines, attributed to cataract.
• Ten eyes needed cataract surgery within three years.
• Counsel patients about cataract before choosing a lens-sparing approach.

Why it matters

It gives medium-term data for a lens-sparing option in a disease where cataract surgery is usually the first move.

Don't overread it

A single-arm prospective study of 70 eyes cannot show the approach is better than lens extraction or trabeculectomy.

The statistics, in plain English

A qualified success of 84.3% counts eyes that met the pressure target with medication, so it is more generous than complete success of 54.3%. Without a control group we cannot tell how much of the pressure fall is due to the operation as opposed to ordinary variation or earlier treatment.

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