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Ghasem Fakhraie*, MD, Mahmoud Jabbarvand , MD, Yadollah Eslami , MD,

Phacoemulsification with Goniosynechialysis in the Management of Refractory Acute Angle-closure Glaucoma. Ghasem Fakhraie*, MD, Mahmoud Jabbarvand , MD, Yadollah Eslami , MD, Sasan Moghimi , MD, Zakieh Vahedian , MD.

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Ghasem Fakhraie*, MD, Mahmoud Jabbarvand , MD, Yadollah Eslami , MD,

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  1. Phacoemulsification with Goniosynechialysis in the Management of Refractory Acute Angle-closure Glaucoma Ghasem Fakhraie*, MD, MahmoudJabbarvand, MD, YadollahEslami, MD, SasanMoghimi, MD, ZakiehVahedian, MD. Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran The authors have no financial interest in the subject matter of this e-poster. Farabi Eye Hospital TUMS

  2. Introduction • Peripheral iridotomy (PI) which creates a bypass route for aqueous passage could effectively break the acute attack of angle-closure glaucoma in most cases, and is therefore considered the first line treatment for primary angle closure glaucoma; however, there are some cases which do not respond to this intervention alone.

  3. Introduction • Because the anterior lens surface has a pivotal role in pupillary block mechanism, lens extraction either clear or cataractous has been proposed as one of the treatment modalities of angle closure glaucoma.1-4

  4. Introduction • Purpose: • To evaluate the effectiveness of phacoemulsification and goniosynechialysis for patients with primary acute angle closure glaucoma (AACG) whose attack could not be broken by PI and anti-glaucoma medications.

  5. Materials and Methods • Study Design: • Prospective, noncomparative, interventional case series. • Patients: • Cases with primary AACG who were unresponsive to conventional medical therapy and laser PI. • Intervention: • Temporal, 3.2 mm-sized clear corneal phacoemulsification and viscogoniosynechialysis with implantation of an intraocular lens.

  6. Materials and Methods • Outcome measures: • Complete success: if intraocular pressure (IOP) showed a drop of at least 30% and was 6-21 mmHg without medication. • Qualified success: if IOP was within above range with glaucoma medication. • Overall success: if IOP was within above range with or without glaucoma medication.

  7. Table 1. Demographic data and baseline clinical characteristics Results • 24 eyes of 24 cases were included. • Mean follow up time: 15.71 ± 4.17 months (range, 6-24). • Patients’ demographics and clinical characteristics are shown in Table . SD= Standard deviation; SE=Spherical equivalent; BCVA=Best corrected visual acuity; IOP=Intraocular pressure

  8. Results Table 2. Pre- and Post-operative parameters • Table 2 shows Pre- and post-operative parameters. • Figure 1 shows baseline and postoperative IOPs at follow up set points. Figure 1. Baseline and follow up set points mean IOPs

  9. Results • Success rate at last visit: • Complete: 17 cases (71%) • Qualified: 5 cases (21%) • Overall: 22 cases (92%) • Failure rate at last visit: 2 cases (8%) • There was a moderate negative correlation between the preoperative anterior chamber depth and last visit IOP drop(p= 0.03, r= -0.56) (Figure 2). Figure 2. Correlation between preoperative anterior chamber depth and intraocular pressure (IOP)drop

  10. Results • There was a moderate positive correlation between the estimated attack-surgery interval and last visit IOP (p < 0.001, r=0.697) (Figure 3). Figure 2. Correlation between the estimated attack-surgery interval and intraocular pressure(IOP)

  11. Conclusions • Phacoemulsification with goniosynechialysis proved to be a safe and effective method for the management of patients with refractory AACG. • It seems that it can be considered as the procedure of choice for these patients before proceeding with filtering surgery.

  12. References • Razeghinejad MR. Combined phacoemulsification and viscogoniosynechialysis in patients with refractory acute angle-closure glaucoma. J Cataract Refract Surg. 2008;34:827-30. • Razeghinejad MR, Rahat F. Combined phacoemulsification and viscogoniosynechialysis in the management of patients with chronic angle closure glaucoma. IntOphthalmol. 2010;30:353-9. • Zhuo YH, Wang M, Li Y, Hao YT, Lin MK, Fang M, Ge J. Phacoemulsification treatment of subjects with acute primary angle closure and chronic primary angle-closure glaucoma. J Glaucoma. 2009;18:646-51. • Vizzeri G, Weinreb RN. Cataract surgery and glaucoma. Curr Opin Ophthalmol. 2010 Jan;21(1):20-4.

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