Efficacy and safety of PEI combined with goniosynechialysis and goniotomy in the treatment of acute primary angle closure glaucoma.

OBJECTIVE

To evaluate the efficacy and safety profile of combined phacoemulsification with intraocular lens implantation (PEI), goniosynechialysis (GSL), and goniotomy (GT) in managing acute primary angle-closure glaucoma (APACG) with cataract.

METHODS

This prospective case series enrolled 53 eyes from 53 APACG patients (mean age 66.43 ± 8.74 years) at Fuzhou Eye Hospital (2022-2024). All subjects underwent triple surgery (PEI + GSL + GT). Primary endpoints included intraocular pressure (IOP) reduction, anti-glaucoma medication(AGM) burden, and complications over 36 months. Surgical success was defined as IOP 5-21 mmHg with ≥ 20% reduction from the baseline without vision-threatening complications. Statistical analyses employed paired t-tests and Wilcoxon signed-rank tests.

RESULTS

At 36 months postoperatively, the qualified success rate(IOP control with medications) reached 76.92%. Mean IOP decreased from 38.52 ± 10.56 mmHg preoperatively to 17.12 ± 4.54 mmHg at 36 months (Δ55.6%, P < 0.001), paralleled by a 71.8% reduction in AGM(from 3.02 ± 0.6 to 0.85 ± 0.8 agents, P < 0.001). Postoperative complications included transient IOP elevation (26.42%, 14/53), corneal edema (15.09%, 8/53), and anterior chamber hemorrhage (11.32%, 6/53), all managed conservatively without sight-threatening events or secondary surgical interventions.

CONCLUSIONS

In this study, PEI + GSL + GT demonstrates significant reductions in IOP and medication burden in APACG. This minimally invasive approach integrates triple therapeutic mechanisms, namely cataract extraction, peripheral anterior synechiolysis (PAS) and trabecular meshwork excision, to reconstruct physiological outflow pathways. This represents a safe surgical alternative. It is recommended that further large-scale multicentre randomised trials are conducted in order to validate the efficacy of the treatment in the APACG and to standardise optimised surgical protocols.