Comparative efficacy and safety of phacoemulsification with intraocular lens implantation combined with goniosynechialysis versus phaco-trabeculectomy in primary angle-closure glaucoma with extensive peripheral anterior synechiae and cataract: a retrospective study.

OBJECTIVE

To compare the efficacy and safety of phacoemulsification combined with goniosynechialysis versus phaco-trabeculectomy in patients with PACG complicated by cataract.

METHODS

We conducted a retrospective analysis of clinical data from 80 eyes of patients with PACG and cataract, treated at Jianhu County People's Hospital between January 2023 and January 2025. P Patients underwent either phacoemulsification plus goniosynechialysis (n = 40) or phacoemulsification plus trabeculectomy (n = 40). We measured ACD, ACA, IOP, and corneal astigmatism both preoperatively and at 12 months postoperatively. We also evaluated visual acuity outcomes and the incidence of postoperative complications.

RESULTS

Baseline characteristics were comparable between groups. At 12 months post-surgery, two groups showed marked improvements in ACD and ACA, with a significant reduction in IOP compared to baseline (all P < 0.05). The goniosynechialysis group demonstrated a significantly greater increase in ACA (38.43° vs. 33.13°, P < 0.001) and better control of corneal astigmatism (1.18D vs. 2.31D, P < 0.001). The visual improvement rates were similar between groups (82.5% vs. 67.5%, P = 0.126). The incidence of postoperative complications was significantly lower in the goniosynechialysis group (7.5% vs. 27.5%, P = 0.019).

CONCLUSION

In PACG patients with cataract and extensive PAS, phacoemulsification combined with goniosynechialysis achieved better anterior chamber angle opening, less postoperative astigmatism, and fewer complications than phaco-trabeculectomy, while providing comparable improvements in ACD, IOP, and visual outcomes at 12 months.