The British journal of ophthalmology · 2026
Three-year outcomes of combined surgical peripheral iridectomy, goniosynechialysis and goniotomy for advanced primary angle-closure glaucoma: a multicentre study.
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Lin Fengbin, Tang Li, Zhu Xiaomin, Zhang Hengli, Wen Tingli, Tang Guangxian, Lu Lan, Fan Sujie, Xiao Meichun, Zhang Xin, Song Yunhe, Peng Yuying, Zhou Fengqi, Chen Weirong, Barton Keith, Park Ki Ho, Aung Tin, Weinreb Robert N, Tham Clement C, Lam Dennis S C, Xie Lin, Xu Jiangang, Wang Ningli, Zhang Xiulan, TVG study group
Аннотация
AIMS: To assess the 3-year efficacy and safety of combined surgical peripheral iridectomy (SPI), goniosynechialysis (GSL) and goniotomy (GT) for advanced primary angle-closure glaucoma (PACG) without cataract.
METHODS: This was a multicentre prospective observational study with extended follow-up. We enrolled advanced PACG without cataract patients who underwent combined SPI+GSL+ GT and completed 36-month follow-up. Key outcomes included changes in intraocular pressure (IOP), best-corrected visual acuity (BCVA), usage of anti-glaucoma medications, surgical success rates, progression of peripheral anterior synechiae (PAS), endothelial cell density, visual field (VF) mean deviation (MD) and long-term postoperative complications.
RESULTS: A total of 70 eyes from 58 patients were included in the final analysis. Baseline mean IOP (29.4±8.1 mm Hg) decreased to 16.4±4.01 mm Hg at 36 months (40.7±18.8% reduction, p<0.001), with anti-glaucoma medications declining from 2.0±1.4 to 0.7±0.9 (p<0.001), representing a 65.7% reduction in required medications postoperatively. At the 3-year follow-up, the cumulative complete and qualified success rates were 54.3% and 84.3%, respectively. Median BCVA worsened slightly (0.00 vs 0.10 logarithm of the minimum angle of resolution, p<0.001); 21.4% of eyes had significant vision loss (≥2 Snellen lines), attributable to cataract progression. MD of VF remained stable (p=0.217). Main late complications were cataract requiring surgery (n=10) and persistent PAS (n=11), with no vision-threatening events. Older age correlated with higher 3-year surgical success (p<0.05).
CONCLUSIONS: Combined SPI+GSL+GT provides sustained IOP reduction, stable visual function, and a favourable safety profile over 3 years, supporting its role as a reliable long-term treatment for advanced PACG without cataract.
METHODS: This was a multicentre prospective observational study with extended follow-up. We enrolled advanced PACG without cataract patients who underwent combined SPI+GSL+ GT and completed 36-month follow-up. Key outcomes included changes in intraocular pressure (IOP), best-corrected visual acuity (BCVA), usage of anti-glaucoma medications, surgical success rates, progression of peripheral anterior synechiae (PAS), endothelial cell density, visual field (VF) mean deviation (MD) and long-term postoperative complications.
RESULTS: A total of 70 eyes from 58 patients were included in the final analysis. Baseline mean IOP (29.4±8.1 mm Hg) decreased to 16.4±4.01 mm Hg at 36 months (40.7±18.8% reduction, p<0.001), with anti-glaucoma medications declining from 2.0±1.4 to 0.7±0.9 (p<0.001), representing a 65.7% reduction in required medications postoperatively. At the 3-year follow-up, the cumulative complete and qualified success rates were 54.3% and 84.3%, respectively. Median BCVA worsened slightly (0.00 vs 0.10 logarithm of the minimum angle of resolution, p<0.001); 21.4% of eyes had significant vision loss (≥2 Snellen lines), attributable to cataract progression. MD of VF remained stable (p=0.217). Main late complications were cataract requiring surgery (n=10) and persistent PAS (n=11), with no vision-threatening events. Older age correlated with higher 3-year surgical success (p<0.05).
CONCLUSIONS: Combined SPI+GSL+GT provides sustained IOP reduction, stable visual function, and a favourable safety profile over 3 years, supporting its role as a reliable long-term treatment for advanced PACG without cataract.