Goniosynechialysis does not enhance phacoemulsification-induced IOP reduction

This multicenter trial assessed the ability of phacoemulsification with goniosynechialysis to reduce IOP through 1 year.

Study design

This randomized clinical trial included 78 patients with primary angle closure or primary angle-closure glaucoma and at least 90° peripheral anterior synechiae with cataract. They were randomized to cataract removal, with or without goniosynechialysis, and followed for 1 year postoperatively.

Outcomes

Both groups experienced a decrease in IOP with significantly less medication. At 1 year, cataract surgery alone reduced IOP from 22.3 mm Hg to 14.3 mm Hg, while the addition of goniosynechialysis reduced IOP from 22.9 mm Hg to 15.9 mm Hg. There were 3 postoperative complications in each group including IOP spike, excessive anterior chamber inflammation and posterior capsule opacification.

Limitations

The study did not standardize the goniosynechialysis technique and lacked a measure for defining success of opening the angle. Goniosynechialysis did not significantly increase complications.

Clinical significance

This study showed no clear advantage of adding goniosynechialysis to phacoemulsification in patients with chronic angle closure.