ArticleClinical ophthalmology (Auckland, N.Z.)2026
The Adjunctive Effect of Goniotomy Combined with Phacoemulsification and Goniosynechialysis for Advanced Primary Angle-Closure Glaucoma with 360° Angle Closure: 12-Month Outcomes.
Article in Clinical ophthalmology (Auckland, N.Z.), 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
Purpose: To compare phacoemulsification with intraocular lens implantation and goniosynechialysis, with or without adjunctive goniotomy, in advanced primary angle-closure glaucoma with complete circumferential angle closure. Design: Retrospective comparative study. Methods: This study included 61 eyes undergoing phacoemulsification and goniosynechialysis without (N=31) or with adjunctive goniotomy (N=30), with at least 12 months of follow-up. A peripheral anterior synechiae of 360° was confirmed by gonioscopy and ultrasound biomicroscopy. The primary outcome was month-12 intraocular pressure (IOP). Longitudinal generalized estimating equations adjusted for baseline IOP, age, sex, and vertical cup-to-disc ratio. Secondary outcomes included medication use, surgical success, postoperative angle status, and complications. Results: At month 12, mean IOP was 16.26 ± 3.03 mmHg in the group without goniotomy and 16.63 ± 3.29 mmHg in the group with goniotomy. The adjusted between-group difference was -0.46 mmHg (95% CI -1.97 to 1.04, P=0.54), below the post hoc exploratory margins of 4, 3, and 2 mmHg. Medication use had no significant difference between groups (P=0.89). Complete and qualified success rates were similar at IOP thresholds of ≤21, ≤18, and ≤15 mmHg combined with at least 20% IOP reduction, with comparable cumulative success rate. Hyphema occurred in 1/31 eyes (3.2%) and 9/30 eyes (30.0%) in groups without and with adjunctive goniotomy (absolute risk difference, 26.8 percentage points, 95% CI, 7.7 to 45.8, P<0.01). Conclusions: In advanced PACG eyes with 360° angle closure, the differences between the 12-month IOP control, surgical success, and medication reduction of the two groups showed no statistically significance. Routine addition of goniotomy may not provide additional benefit.
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