Effective treatment for secondary angle-closure glaucoma caused by traumatic lens subluxation: phacoemulsification with capsular-tension-ring implantation combined with ophthalmic endoscope-controlled goniosynechialysis

AIM: To investigate the safety and efficacy of phacoemulsification with capsular-tension-ring implantation and posterior chamber intraocular lens implantation combined with ophthalmic endoscope-controlled goniosynechialysis (Phaco-CTR-IOL-OE-GSL) for treating secondary angle-closure glaucoma induced by traumatic lens subluxation. METHODS: A retrospective and descriptive study was performed on patients with lens subluxation, angle closure, goniosynechia, and evaluated intraocular pressure (IOP) that cannot be controlled with medication, who underwent Phaco-CTR-IOL-OE-GSL. The postoperative best-corrected visual acuity (BCVA), IOP, range of goniosynechia and complications were retrospectively observed. RESULTS: Nine patients with secondary angle-closure glaucoma induced by traumatic lens subluxation were included. The follow-up period was 51.1 +/- 8.6mo. The preoperative range of zonule rupture was 158.2 degrees +/- 33.0 degrees, and the range of goniosynechia was 220.0 degrees +/- 92.5 degrees. The baseline BCVA was 0.9 +/- 1.0 logMAR, IOP was 30.7 +/- 17.3 mm Hg, and number of anti-glaucoma medication was 3.2 +/- 1.1. Mild intraoperative hyphaemia with 8 eyes (88.8%) in the anterior chamber, and was absorbed two days postoperatively. One eye (11.1%) had postoperative ciliary body detachment and was recovered after five days of topical drug treatment. BCVA was 0.2 +/- 0.2 logMAR at 3mo postoperatively. The average IOP at the last follow-up was 16.7 +/- 2.0 mm Hg, and no anti-glaucoma medications were used. The average range of recurrent goniosynechia was 54.9 degrees +/- 33 degrees at the final postoperative gonioscopic examination. CONCLUSION: Phaco-CTR-IOL-OE-GSL is safe and effective in the treatment of secondary angle-closure glaucoma induced by traumatic lens subluxation. The use of an endoscope provides a more direct and clear examination for GSL, and 360 degrees dissection is easily achieved.