Angle surgery without lens extraction held IOP for three years in advanced angle closure

Design

Multicentre prospective observational study, 3-year follow-up

Population

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

Primary outcome

IOP, medications and surgical success at 36 months

Effect

IOP 29.4 to 16.4 mmHg; medications 2.0 to 0.7; complete success 54.3%, qualified 84.3%

This multicentre prospective observational study followed 70 eyes of 58 patients with advanced primary angle-closure glaucoma and no cataract for three years after combined surgical peripheral iridectomy, goniosynechialysis and goniotomy.

Mean IOP fell from 29.4 to 16.4 mmHg, about a 41% reduction, and the number of glaucoma medications fell from about two to under one. At three years, complete success was 54% and qualified success 84%. Visual field mean deviation was stable. About a fifth of eyes lost two or more lines of vision, attributed to cataract progression, and ten needed cataract surgery. There were no vision-threatening complications. Older patients did better.

For advanced angle closure in a clear-lens eye, the usual choices are trabeculectomy, lens extraction or both. This combined angle procedure offers a less invasive option, but without a comparison group it cannot show it is better than either.

It is a reasonable option to consider in experienced hands, with patients told that cataract surgery may follow. A randomised comparison against lens extraction and trabeculectomy is the next step.

• Consider combined iridectomy, goniosynechialysis and goniotomy for advanced angle closure without cataract, in experienced hands.
• Tell patients that cataract progression and later cataract surgery are common.
• Monitor for persistent or recurrent peripheral anterior synechiae.
• Follow visual fields; stability was the main functional outcome here.
• Weigh it against lens extraction and trabeculectomy case by case.

Why it matters

It offers a less invasive surgical path for a disease that is especially common in India and Asia.

Don't overread it

Single-arm observational study; it does not show superiority over lens extraction or trabeculectomy.

The statistics, in plain English

84% qualified success means pressure targets were met with or without drops in most eyes; 54% met them without drops. With 70 eyes and no control group, these figures describe what happened, not how it compares with trabeculectomy or lens extraction.

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