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Glaucoma
Clinical science
Two-year outcome of phacogoniotomy for advanced primary angle-closure glaucoma with cataracts: a multicentre study
  1. Yunhe Song1,
  2. Lin Xie2,
  3. Xiaomin Zhu2,
  4. Sujie Fan3,
  5. Aiguo Lv3,
  6. Guangxian Tang4,
  7. Hengli Zhang4,
  8. Li Tang5,
  9. Yao Zhang5,
  10. Lan Lu6,
  11. Meichun Xiao6,
  12. Huiping Yuan7,
  13. Wulian Song7,
  14. Minwen Zhou8,
  15. Xiaohuan Zhao8,
  16. Zhixuan Wang1,
  17. Fengbin Lin1,
  18. Xiaohong Liang1,
  19. Yuying Peng1,
  20. Yu Chen1,
  21. Zhenyu Wang9,
  22. Ling Jin1,
  23. Ki Ho Park10,
  24. Keith Barton11,
  25. Weirong Chen1,
  26. Ningli Wang12,
  27. Ying Han13,
  28. Dennis Lam14,
  29. Robert Weinreb15,
  30. Tin Aung16,
  31. Clement C Tham17,
  32. Xiulan Zhang18
  33. PVP study group
    1. 1 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
    2. 2 Department of Ophthalmology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
    3. 3 Handan City Eye Hospital, The Third Hospital of Handan, Handan 056001, China
    4. 4 Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang 050000, Hebei Province, China
    5. 5 Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
    6. 6 Department of Ophthalmology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
    7. 7 Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
    8. 8 Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
    9. 9 Dermatology Hospital, Southern Medical University, Guangzhou, China
    10. 10 Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
    11. 11 NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
    12. 12 Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
    13. 13 Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
    14. 14 CMER International Eye Research Center, The Chinese University of Hong Kong (Shenzhen), Shenzhen, People's Republic of China
    15. 15 Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
    16. 16 Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
    17. 17 Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
    18. 18 Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
    1. Correspondence to Professor Xiulan Zhang; zhangxl2{at}mail.sysu.edu.cn; Professor Clement C Tham; clemtham{at}cuhk.edu.hk

    Abstract

    Purpose To report the 2-year effective and safety profile of integrated phacoemulsification with intraocular lens implantation (PEI), goniosynechialysis (GSL) and 120° goniotomy (GT) in advanced primary angle-closure glaucoma (PACG) and cataracts.

    Design Multicentre prospective study.

    Methods 201 eyes of 196 patients who received combined PEI+GSL+ GT were assessed at baseline and re-evaluated at days 1, 7, and at 1, 3, 6, 12 and 24 months postsurgery. The intraocular pressure (IOP), the number of topical hypotensive medications, surgical complications and achievements of surgery success were also evaluated.

    Results All participants were followed up for a 2-year period. The average IOP declined from 33.0±10.7 mm Hg to 13.6±2.9 mm Hg, and the number of topical hypotensive medication decreased from an average of 2.4 types to 0.4 at month 24. For the safety profile, the major complications were hyphema (n=14, 7.0%), IOP spike (n=9, 4.9%) and transit corneal oedema (n=23, 11.4%). The complete success was achieved in 72.6% of the eyes (146 out of 201), and the qualified success rate was 91.5% (184 out of 201). Only one eye required tube shunt surgery while no one developed severe vision-threatening complications. The best-corrected visual acuity increased from 0.80±1.08 to 0.54±0.78 LogMAR.

    Conclusions PEI+GSL+GT is shown to be effective and safe in treating advanced PACG with cataract over a 2-year follow-up period. The combined surgery may be considered as an alternative for patients with advanced PACG.

    • Glaucoma
    • Wound healing
    • Treatment Surgery

    Data availability statement

    Data are available on reasonable request.

    https://doi.org/10.1136/bjo-2024-325375

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      Data availability statement

      Data are available on reasonable request.

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      Footnotes

      • Collaborators Phacotrabeculectomy versus Phacogoniotomy (PVP) study group: Principal investigators: Xiulan Zhang, Huiping Yuan, Li Tang, Guangxian Tang, Lan Lu, Sujie Fan, Minwen Zhou, and Lin Xie. Principle center: Zhongshan Ophthalmic Center, Sun Yat-sen University Coordinating centers: Department of Ophthalmology, 2nd Affiliated Hospital, Harbin Medical University Department of Ophthalmology, West China Hospital of Sichuan University Department of Ophthalmology, Shijiazhuang People’s Hospital Department of Ophthalmology, Fujian Medical University Union Hospital Department of Ophthalmology, Shanghai General Hospital Handan City Eye Hospital (Third Hospital of Handan) Department of Ophthalmology, Third Affiliated Hospital of Chongqing Medical University. Steering committee: Robert N Weinreb, Dennis SC Lam, Ningli Wang Data Safety and Monitoring Committee: Keith Barton, Ki-Ho Park, Tin Aung, and Clement C Tham.

      • Contributors Study design: XZhan; Data collection: XZhu, AL, HZ, YZ, MX, WS, XZha, MZ, HY, LL, LT, ZheW, FL, XL, YP, YC, ZhiW, LJ and WC; Data analysis and interpretation: YS and ZheW; Manuscript drafting: YS; Manuscript revision: XZhan, RW, TA, CCT, DL, NW, YH, KHP and KB.

      • Funding This research is supported by the National Key R&D Program of China (2022YFC2502800); National Natural Science Foundation of China (No.81670860); Chongqing Natural Research Foundation (No.cstc 2018jcyjAX0034). Chongqing Natural Research Foundation (No: CSTB2022NSCQ-MSX0077); The Science and Technology Program of Sichuan Province (2020YJ0289); National Natural Science Foundation of China (82101139), Fujian provincial health technology project (2022CXA016); Medical application technology tracking project in Hebei Province (GZ2022094).

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.