Phacoemulsification with Goniosynechialysis in the Management of Refractory Acute Angle-closure Glaucoma Ghasem Fakhraie*, MD, Mahmoud Jabbarvand, MD, Yadollah Eslami, MD, Sasan Moghimi, MD, Zakieh Vahedian, MD. Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran The authors have no financial interest in the subject matter of this e-poster. TUMS Farabi Eye Hospital

Introduction  Peripheral iridotomy (PI) which creates a bypass route for aqueous passage could effectively break the acute attack of angle-closure glaucoma in most cases, and is therefore considered the first line treatment for primary angle closure glaucoma; however, there are some cases which do not respond to this intervention alone.

Introduction  Because the anterior lens surface has a pivotal role in pupillary block mechanism, lens extraction either clear or cataractous has been proposed as one of the treatment modalities of angle closure glaucoma. 1-4

Introduction  Purpose: To evaluate the effectiveness of phacoemulsification and goniosynechialysis for patients with primary acute angle closure glaucoma (AACG) whose attack could not be broken by PI and anti-glaucoma medications.

Materials and Methods  Study Design: Prospective, noncomparative, interventional case series.  Patients: Cases with primary AACG who were unresponsive to conventional medical therapy and laser PI.  Intervention: Temporal, 3.2 mm-sized clear corneal phacoemulsification and viscogoniosynechialysis with implantation of an intraocular lens.

Materials and Methods  Outcome measures: Complete success: if intraocular pressure (IOP) showed a drop of at least 30% and was 6-21 mmHg without medication. Qualified success: if IOP was within above range with glaucoma medication. Overall success: if IOP was within above range with or without glaucoma medication.

 24 eyes of 24 cases were included.  Mean follow up time: ± 4.17 months (range, 6-24).  Patients’ demographics and clinical characteristics are shown in Table. VariableDescription Age Mean ± SD Range ± Gender Male Female 11 (46%) 13 (54%) SE refractive error (Diopter) Mean ± SD Range 2.39± Axial length (mm) Mean ± SD Range 22.15± LogMAR BCVA Mean ± SD Range 0.57 ± IOP (mmHg) Mean ± SD Range ± Antiglaucoma medication Mean ± SD Range 3.67 ± Estimated attack-surgery interval (Week) Mean ± SD Range 7.32 ± Anterior chamber depth (mm) Mean ± SD Range 2.29 ± Table 1. Demographic data and baseline clinical characteristics SD= Standard deviation; SE=Spherical equivalent; BCVA=Best corrected visual acuity; IOP=Intraocular pressure Results

 Table 2 shows Pre- and post-operative parameters.  Figure 1 shows baseline and postoperative IOPs at follow up set points. Results Figure 1. Baseline and follow up set points mean IOPs VariablePreoperativeLast visitP-value Mean IOP (mmHg) ± ± 3.21< Mean number of glaucoma medication 3.67 ± ± 1.05< LogMAR Best corrected visual acuity 0.57 ± ± 0.23< Table 2. Pre- and Post-operative parameters

 Success rate at last visit: – Complete: 17 cases (71%) – Qualified: 5 cases (21%) – Overall: 22 cases (92%)  Failure rate at last visit : 2 cases (8%) Figure 2. Correlation between preoperative anterior chamber depth and intraocular pressure (IOP)drop Results  There was a moderate negative correlation between the preoperative anterior chamber depth and last visit IOP drop (p= 0.03, r= -0.56) (Figure 2).

Results  There was a moderate positive correlation between the estimated attack-surgery interval and last visit IOP (p < 0.001, r=0.697) (Figure 3). Figure 2. Correlation between the estimated attack- surgery interval and intraocular pressure(IOP)

Conclusions  Phacoemulsification with goniosynechialysis proved to be a safe and effective method for the management of patients with refractory AACG.  It seems that it can be considered as the procedure of choice for these patients before proceeding with filtering surgery.

References 1.Razeghinejad MR. Combined phacoemulsification and viscogoniosynechialysis in patients with refractory acute angle-closure glaucoma. J Cataract Refract Surg. 2008;34: Razeghinejad MR, Rahat F. Combined phacoemulsification and viscogoniosynechialysis in the management of patients with chronic angle closure glaucoma. Int Ophthalmol. 2010;30: Zhuo YH, Wang M, Li Y, Hao YT, Lin MK, Fang M, Ge J. Phacoemulsification treatment of subjects with acute primary angle closure and chronic primary angle-closure glaucoma. J Glaucoma. 2009;18: Vizzeri G, Weinreb RN. Cataract surgery and glaucoma. Curr Opin Ophthalmol Jan;21(1):20-4.