Outcomes of phaco-goniosynechialysis surgery for refractory acute primary angle-closure glaucoma after trabeculectomy complicated by low corneal endothelial cell density.

PURPOSE: To evaluate the efficacy and safety of phacoemulsification combined with goniosynechialysis (phaco + GSL) in patients with acute primary angle-closure glaucoma (APACG) after failed trabeculectomy, complicated by refractory glaucoma and low corneal endothelial cell density (CECD).

METHODS

Fourteen patients with APACG whose intraocular pressure (IOP) was uncontrolled after trabeculectomy were enrolled in this retrospective study. These patients also had a CECD < 900 cells/mm2. The patients were enrolled between August 2020 and June 2024. Preoperative and postoperative IOP, CECD, best-corrected visual acuity (BCVA), the number of IOP-lowering medications, anterior chamber depth, and postoperative complications were recorded.

RESULTS

The mean CECD increased from 756.6 ± 106.2 cells/mm2 preoperatively to 1138.18 ± 221.88 cells/mm2 at 6 months postoperatively. Mean IOP decreased from 34.54 ± 10.61 mmHg preoperatively to 13.21 ± 2.51 mmHg postoperatively. The mean number of IOP-lowering medications decreased from 2.82 ± 1.47 to 0.09 ± 0.30 pre- and postoperatively, respectively. The mean time between trabeculectomy and phaco + GSL was 4.0 ± 3.61 months. Thirteen of the 14 eyes (92.86%) showed improved BCVA; one eye (7.14%) showed decreased BCVA because of associated retinitis pigmentosa. No corneal endothelial decompensation was observed. The mean anterior chamber depth increased from 1.47 ± 0.26 mm preoperatively to 2.81 ± 0.38 mm postoperatively. The mean extent of peripheral anterior synechiae decreased from 351.43° ± 24.78°-117.14° ± 23.30°

CONCLUSIONS

Early postoperative evaluation of CECD may not reflect the true corneal endothelial status in APACG. Even after failed trabeculectomy, with uncontrolled IOP and a CECD < 900 cells/mm2, phaco + GSL is an effective and safe approach to reduce IOP and the number of IOP-lowering medications and to partially improve visual acuity, with no serious complications.