Microcoaxial Phacoemulsification Combined With Viscogoniosynechialysis for Patients With Refractory Acute Angle-closure Glaucoma

Purpose:To evaluate the safety and efficacy of microcoaxial phacoemulsification combined with viscogoniosynechialysis in managing refractory acute angle-closure glaucoma (AACG) unresponsive to conventional therapy.Methods:Seventeen consecutive eyes of patients with AACG>270 degrees peripheral anterior synechiae were treated with microcoaxial phacoemulsification combined with viscogoniosynechialysis. After intraocular lens implantation, a heavy viscoelastic agent was used to deepen the anterior chamber, and then injected near the angle for 360 degrees without touching any ocular structure, to release the peripheral anterior synechiae under gonioscopy. The viscoelastic agent was then removed.Results:Intraocular pressure was reduced from a median of 45.0 mm Hg initially to 15.0 mm Hg after the combined procedures at the final follow-up visit (P<0.001). All angles showed exposure of the trabecular meshwork over 360 degrees postoperatively without residual synechiae. The mean best corrected visual acuity improved from 0.7 to 0.18 logMAR at 6-month follow-up (P<0.001). Surgically induced astigmatism was 0.29 at 6-month follow-up. There was a 6.4% reduction in the mean corneal endothelial cell count. No severe complications were observed in any patient.Conclusions:Microcoaxial phacoemulsification combined with viscogoniosynechialysis is an effective and safe treatment for managing refractory AACG. Using a 2.2-mm incision caused less surgically induced astigmatism and also improved visual quality.