ArticleBMC ophthalmology2026
Phacoemulsification with goniosynechialysis for nanophthalmos with secondary angle-closure or secondary angle-closure glaucoma: a 20-case series and stepwise management strategy.
Article in BMC ophthalmology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNanophthalmos is a rare congenital ocular disorder characterized by a short axial length (AL), which predisposes to secondary angle-closure and secondary angle-closure glaucoma. Surgical management is challenging due to high complication risks. This study aimed to evaluate the feasibility and efficacy of phacoemulsification with intraocular lens implantation and goniosynechialysis (Phaco + IOL+GSL) in nanophthalmos with secondary angle-closure or secondary angle-closure glaucoma, and to propose a stepwise complication management strategy.
methodsThis retrospective case series included 20 eyes of 20 patients diagnosed with nanophthalmos (AL < 20 mm) and PAC (2 eyes) or ACG (18 eyes) who underwent Phaco + IOL+GSL between January 2022 and Jun 2025. Patients were divided into three groups based on AL: Group A (14 mm ≤ AL < 16 mm, 9 eyes), Group B (16 mm ≤ AL < 18 mm, 4 eyes), and Group C (18 mm ≤ AL < 20 mm, 7 eyes). Preoperative and postoperative uncorrected visual acuity (UCVA, logMAR) and best-corrected visual acuity (BCVA, logMAR) were recorded, intraocular pressure (IOP), number of antiglaucoma medications, and intraoperative and postoperative complications were analyzed.
resultsAt the final follow-up (6-12 months postoperatively), the median IOP significantly decreased from 25.5 [16.0, 35.0] mmHg to 16.0 [14.0, 19.0] mmHg (P < 0.05). The median number of antiglaucoma medications decreased from 2.5 [0.0, 4.0] to 0.0 [0.0, 0.0] (P < 0.05). UCVA improved from 1.30 [1.00, 1.70] to 0.40 [0.12, 1.10] (P < 0.05), and BCVA improved from 0.82 [0.40, 1.30] to 0.50 [0.30, 0.90] (P < 0.05).The qualified success rate was 95.0% (19/20), and the complete success rate was 80.0% (16/20). The intraoperative complication rate was 25.0% (5/20), primarily shallow anterior chamber. The postoperative complication rate was 40.0% (8/20), primarily shallow anterior chamber with elevated IOP. Complications were concentrated in Groups A and B. A stepwise management strategy-initiating with medical/laser therapy, escalating to cyclophotocoagulation, and reserving pars plana vitrectomy for refractory cases-achieved successful complication management.
conclusionFor nanophthalmos with secondary angle-closure glaucoma, Phaco + IOL+GSL appears to be a feasible and effective procedure, particularly when combined with a stepwise complication management strategy. It may serve as an initial surgical option before resorting to more invasive combined procedures. However, the high complication rate in eyes with AL < 16 mm warrants extreme caution and readiness for escalation. The retrospective design and small sample size limit the generalizability of our findings; larger prospective studies are needed to confirm these results.
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