Purpose: To evaluate the effectiveness of phacoemulsification with goniosynechialysis in the management of refractory acute angle closure (AAC).
Methods: In this prospective, noncomparative interventional case series, patients with AAC who were unresponsive to medical and laser therapy were included. Success was defined as complete if intraocular pressure (IOP) had a drop of at least 30% and was between 6 and 21 mmHg without medication, and qualified if IOP was within that range with medication.
Results: A total of 24 patients with a mean age of 56 years (range 39-77) were treated. Mean follow-up time was 15.7 ± 4.2 months (range 6-24). Mean preoperative and last visit IOPs were 34.27 ± 7.23 mmHg and 17.5 ± 3.21 mmHg, respectively (p<0.001). Mean number of glaucoma medication dropped from 3.67 ± 0.48 to 0.63 ± 1.05 (p<0.001). There was a positive correlation between the attack-surgery interval and last visit IOP (p<0.001, r=0.697). There was a negative correlation between the preoperative anterior chamber depth and last visit IOP drop (p=0.03, r=-0.56). Also, a positive correlation was found between the preoperative IOP and last visit IOP drop (p<0.001, r=0.896). At final visit, complete and qualified success was achieved in 17/24 (71%) and 5/24 (21%) cases, respectively. The most common intraoperative and postoperative complications were hyphema and anterior chamber fibrinous reaction, respectively.
Conclusions: Phacoemulsification with goniosynechialysis seems to be a safe and effective method for the management of patients with refractory AAC. This procedure can be considered for these patients before proceeding with filtering surgery.