One-Year Outcomes of Phacoemulsification Combined with Trabecular Micro-Bypass Stent Implantation and Goniosynechialysis in Primary Angle Closure Glaucoma.

Background/

Objectives

Trabecular micro-bypass (iStent) implantation has been shown to effectively reduce intraocular pressure (IOP) and medication burden in open-angle glaucoma. However, its efficacy in primary angle closure glaucoma (PACG) remains unclear. We conducted this study to evaluate the one-year clinical outcomes of phacoemulsification combined with goniosynechialysis and iStent implantation (Phaco-GSL-iStent) in Korean patients with PACG.

Methods

This retrospective study included 65 PACG eyes that underwent Phaco-GSL-iStent with follow-up of ≥12 months. Postoperative changes in mean IOP and glaucoma medications were assessed through postoperative 12 months. Predictors of postoperative changes in IOP and glaucoma medications were also evaluated.

Results

Mean IOP significantly decreased from 18.3 ± 0.4 to 13.8 ± 0.3 mmHg at postoperative 12 months (p < 0.001). Mean number of glaucoma medications showed a statistically significant but small decrease from 2.85 ± 0.15 to 2.44 ± 0.13 at 12 months (p = 0.008). The 12-month cumulative qualified success rate was 86.2%. In multivariable analysis, IOP reduction at postoperative 12 months was positively associated with preoperative IOP (B = 0.707, p < 0.001). IOP spikes (defined as an increase of 5 mmHg or more from the baseline) were observed in two eyes (3.1%).

Conclusions

These one-year outcomes suggest that Phaco-GSL-iStent can be an effective option to lower IOP in patients with PACG. However, the reduction in glaucoma medication use was limited in this study sample.