Efficacy of goniosynechialysis for advanced chronic angle-closure glaucoma

Purpose: To evaluate the intraocular pressure (IOP)-lowering efficacy of goniosynechialysis (GSL) for advanced chronic angle-closure glaucoma (CACG) using a simplified slit-lamp technique. Patients and methods: Patients with CACG with one severely affected eye with best-corrected visual acuity below 20/200 and a mildly or functionally unaffected fellow eye were enrolled in this study. All patients underwent ophthalmologic examinations including measurement of visual acuity, best-corrected visual acuity, and IOP; biomicroscopy; specular microscopy; fundus examination; and gonioscopy followed by anterior chamber paracentesis and GSL for nasal peripheral anterior synechiae in the eye with severe CACG. Results: Thirty patients (18 men, 12 women) were identified as having CACG with an initial mean IOP of 47.1 +/- 6.7 mmHg (range 39-61 mmHg) in the severely affected eye. One week after GSL, the mean IOP of the treated eyes decreased to 19.3 +/- 2.8 mmHg (range 14-26 mmHg) without antiglaucoma medication (average decrease 27.7 +/- 6.5 mmHg; range 16-41 mmHg), which was significant (P < 0.00001) compared with baseline. After an average follow-up period of 36.6 +/- 1.0 months (range 35-38 months), the mean IOP stabilized at 17.4 +/- 2.2 mmHg (range 12-21 mmHg). The nasal angle recess did not close again in any one of the patients during the follow-up period. The average significant (P < 0.00001) decrease in corneal endothelial cell density in the treated eyes was 260 +/- 183 cells/mm(2) (range 191-328 cells/mm(2)). Conclusions: Anterior chamber paracentesis and GSL lowers IOP in advanced CACG, though it may lead to mild corneal endothelial cell loss.