Phacoemulsification with IOL implantation combined with goniosynechialysis and goniotomy in primary angle-closure glaucoma following failed trabeculectomy: short-term effectiveness and safety outcomes.

PURPOSE: To evaluate the short-term effectiveness and safety of Phacoemulsification with intraocular lens implantation combined with goniosynechialysis and goniotomy (PEI-GSL-GT) in eyes with prior failed trabeculectomy compared to surgically naïve eyes.

MATERIALS AND

METHODS

This retrospective study enrolled 40 eyes (34 patients) diagnosed with moderate to advanced primary angle-closure glaucoma (PACG) who received treatment at the Eye Hospital of Nanjing Medical University from November 2024 to November 2025. After excluding one patient lost to follow-up, 39 eyes (33 patients) with at least 3 months of follow-up were finally included. Among them, 17 cases underwent reoperation due to previous trabeculectomy failure, while 22 cases received the surgical intervention for the first time. All eyes underwent the PEI-GSL-GT procedure. The cohort was divided into a Naïve Group (no prior glaucoma surgery) and a Trabeculectomy failure group (prior failed trabeculectomy). Main outcome measures included intraocular pressure (IOP), best-corrected visual acuity (BCVA), the number of anti-glaucoma medications, and postoperative complications. Surgical success was analyzed using Kaplan-Meier survival curves.

RESULTS

Baseline characteristics were comparable between the Naïve (n = 22) and Trabeculectomy failure (n = 17) groups (P > 0.05). At 3 months, mean IOP decreased significantly in both groups (Naïve: 22.05-14.62 mmHg, P = 0.002; Trabeculectomy failure group: 24.53 to 17.00 mmHg, P = 0.035), with no significant between-group differences (P > 0.05). Medication burden was significantly reduced in both cohorts. Exploratory Kaplan-Meier analysis showed no significant difference in short-term cumulative success (Log-rank P = 0.750). Safety profiles were comparable with no vision-threatening complications. BCVA improved in the Naïve Group (P < 0.001) and the Trabeculectomy failure group (P = 0.177).

CONCLUSION

PEI-GSL-GT was associated with significant IOP reduction and reduced medication burden during short-term follow-up. No statistically significant differences were observed between the Trabeculectomy failure group and Naïve groups in most outcomes during the 3-month follow-up.