[Clinical efficacy of combined phacoemulsification and goniosynechialysis with Kahook double-blade goniotomy for treatment of angle-closure glaucoma].

Abstract

Objective: To compare the clinical efficacy and safety of phacoemulsification with goniosynechialysis (Phaco-GSL) versus Phaco-GSL combined with excisional goniotomy using the Kahook dual blade (KDB) in the treatment of primary angle-closure glaucoma with cataract (PACG-C). Methods: A prospective non-randomized case-control study was conducted. Patients with PACG-C scheduled for combined cataract extraction and anti-glaucoma surgery at the Eye Hospital of Shandong First Medical University from March 2023 to December 2024 were enrolled. Based on the disease severity, they were assigned to either the Phaco-GSL-KDB group or the Phaco-GSL group for the corresponding surgical procedure. The visual acuity, intraocular pressure (IOP), number of anti-glaucoma medications used, visual field, and surgical success rate were recorded and compared between the two groups preoperatively, at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively. The paired t-test, Wilcoxon signed-rank test, independent samples t-test, Mann-Whitney U test, Chi-square test, and Friedman test were employed for statistical analysis. Results: A total of 101 patients (116 eyes) with PACG-C who met the inclusion criteria were enrolled, including 32 males (34.81%) and 69 females (65.19%), with a mean age of (67.28±7.07) years. There were 56 patients (61 eyes) in the Phaco-GSL-KDB group and 45 patients (55 eyes) in the Phaco-GSL group. In the Phaco-GSL-KDB group, the number of preoperative anti-glaucoma medications was higher than that in the Phaco-GSL group [3.00 (2.00, 3.00) vs. 2.00 (1.00, 3.00)], while the mean deviation was lower [-23.68 (-28.90, -12.81) dB vs.-12.96 (-23.18, -5.27) dB], with differences being statistically significant (both P<0.05). There were no statistically significant differences between the two groups in baseline parameters such as age, visual acuity, and IOP (all P>0.05). At the 12-month follow-up, the visual acuity improved in both groups compared to preoperative levels (both P<0.05). The IOP decreased in both groups compared to preoperative levels, and the Phaco-GSL-KDB group maintained lower IOP than the Phaco-GSL group at all follow-up time points. At 12 months postoperatively, the reduction in IOP was 47.60% in the Phaco-GSL-KDB group vs. 38.01% in the Phaco-GSL group (both P<0.05). The mean deviation improved, and the pattern standard deviation (PSD) decreased in both groups (all P<0.05). The reduction in PSD in the Phaco-GSL-KDB group was 2.8%. Both the complete success rate and conditional success rate were higher in the Phaco-GSL-KDB group compared to the Phaco-GSL group (both P<0.05). Specifically, the conditional success rate [defined as IOP≤18 mmHg (1 mmHg=0.133 kPa) at 12 months postoperatively] was 91.8% in the Phaco-GSL-KDB group and 70.9% in the Phaco-GSL group. The number of anti-glaucoma medications decreased postoperatively in both groups compared to preoperative levels (both P<0.05). In the Phaco-GSL-KDB group, the number decreased from 3.00 (2.00, 3.00) preoperatively to 1.00 (0.00, 1.00), which was superior to the Phaco-GSL group (P<0.05). No serious postoperative complications occurred in either group. Conclusions: Phaco-GSL-KDB demonstrated superior IOP-lowering efficacy compared to Phaco-GSL in the treatment of PACG. Both combined surgical approaches effectively reduced the number of postoperative anti-glaucoma medications and improved the visual field, indicating favorable therapeutic effectiveness and safety.