Zhenbin Qian, Weihua Pan, Li Nie, Leilei Lin, Liqing Wei
{"title":"Phaco-Goniosynechialysis 对伴有严重视野缺损的晚期原发性闭角型青光眼的疗效和安全性。","authors":"Zhenbin Qian, Weihua Pan, Li Nie, Leilei Lin, Liqing Wei","doi":"10.1097/IJG.0000000000002474","DOIUrl":null,"url":null,"abstract":"<p><strong>Prcis: </strong>Phacoemulsification with goniosynechialysis (phaco-GSL) demonstrates promise in safely and efficiently managing advanced primary angle closure glaucoma (PACG) cases with tunnel vision or limited temporal visual field. However, caution is advised for patients with only one functioning eye or high visual expectations.</p><p><strong>Objective: </strong>To assess the efficacy and safety of phaco-GSL in patients with end-stage PACG exhibiting tubular vision or temporal field island.</p><p><strong>Patients and methods: </strong>This retrospective study evaluated 68 patients (74 eyes) diagnosed with advanced PACG and exhibiting either tubular vision or temporal field island. All patients underwent phaco-GSL and were monitored for at least 1 month postoperatively. The study analyzed changes in visual acuity (VA), intraocular pressure (IOP), medication use for antiglaucoma, and postoperative complications.</p><p><strong>Results: </strong>The mean follow-up time was 9.11 ± 10.49 months. The mean preoperative visual field deviation and VA were -28.01 ± 3.30 dB and 0.36 ± 0.37 log minimum angle of resolution unit, respectively. Postoperatively, the VA for over half (54.1%) of the eyes increased, 29.7% remained unchanged, and 16.2% worsened. The final IOP decreased significantly from 24.65 ± 8.61 to 14.81 ± 3.54 mm Hg. Glaucoma medication use also reduced from 1.46 ± 1.43 to 0.88 ± 1.18. The success rate was 48.6% for complete and 89.2% for qualified. IOP spikes (27.0%) and wipe-out (8.1%) were the most common postoperative complications. Vision recovered gradually in 5 of 6 wipe-out patients. One eye (1.4%) developed permanent vision loss with VA decreasing to hand motion.</p><p><strong>Conclusion: </strong>Phaco-GSL appears safe and effective in treating advanced PACG cases with tubular vision or temporal field island. However, caution is warranted when considering this treatment option for patients at high wipe-out risk or those with high expectations for visual outcomes.</p>","PeriodicalId":15938,"journal":{"name":"Journal of Glaucoma","volume":" ","pages":"900-907"},"PeriodicalIF":2.0000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy and Safety of Phaco-Goniosynechialysis in Advanced Primary Angle Closure Glaucoma With Severe Visual Field Loss.\",\"authors\":\"Zhenbin Qian, Weihua Pan, Li Nie, Leilei Lin, Liqing Wei\",\"doi\":\"10.1097/IJG.0000000000002474\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Prcis: </strong>Phacoemulsification with goniosynechialysis (phaco-GSL) demonstrates promise in safely and efficiently managing advanced primary angle closure glaucoma (PACG) cases with tunnel vision or limited temporal visual field. However, caution is advised for patients with only one functioning eye or high visual expectations.</p><p><strong>Objective: </strong>To assess the efficacy and safety of phaco-GSL in patients with end-stage PACG exhibiting tubular vision or temporal field island.</p><p><strong>Patients and methods: </strong>This retrospective study evaluated 68 patients (74 eyes) diagnosed with advanced PACG and exhibiting either tubular vision or temporal field island. All patients underwent phaco-GSL and were monitored for at least 1 month postoperatively. The study analyzed changes in visual acuity (VA), intraocular pressure (IOP), medication use for antiglaucoma, and postoperative complications.</p><p><strong>Results: </strong>The mean follow-up time was 9.11 ± 10.49 months. The mean preoperative visual field deviation and VA were -28.01 ± 3.30 dB and 0.36 ± 0.37 log minimum angle of resolution unit, respectively. Postoperatively, the VA for over half (54.1%) of the eyes increased, 29.7% remained unchanged, and 16.2% worsened. The final IOP decreased significantly from 24.65 ± 8.61 to 14.81 ± 3.54 mm Hg. Glaucoma medication use also reduced from 1.46 ± 1.43 to 0.88 ± 1.18. The success rate was 48.6% for complete and 89.2% for qualified. IOP spikes (27.0%) and wipe-out (8.1%) were the most common postoperative complications. Vision recovered gradually in 5 of 6 wipe-out patients. One eye (1.4%) developed permanent vision loss with VA decreasing to hand motion.</p><p><strong>Conclusion: </strong>Phaco-GSL appears safe and effective in treating advanced PACG cases with tubular vision or temporal field island. However, caution is warranted when considering this treatment option for patients at high wipe-out risk or those with high expectations for visual outcomes.</p>\",\"PeriodicalId\":15938,\"journal\":{\"name\":\"Journal of Glaucoma\",\"volume\":\" \",\"pages\":\"900-907\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Glaucoma\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/IJG.0000000000002474\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/8/5 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"OPHTHALMOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Glaucoma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/IJG.0000000000002474","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/5 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
Efficacy and Safety of Phaco-Goniosynechialysis in Advanced Primary Angle Closure Glaucoma With Severe Visual Field Loss.
Prcis: Phacoemulsification with goniosynechialysis (phaco-GSL) demonstrates promise in safely and efficiently managing advanced primary angle closure glaucoma (PACG) cases with tunnel vision or limited temporal visual field. However, caution is advised for patients with only one functioning eye or high visual expectations.
Objective: To assess the efficacy and safety of phaco-GSL in patients with end-stage PACG exhibiting tubular vision or temporal field island.
Patients and methods: This retrospective study evaluated 68 patients (74 eyes) diagnosed with advanced PACG and exhibiting either tubular vision or temporal field island. All patients underwent phaco-GSL and were monitored for at least 1 month postoperatively. The study analyzed changes in visual acuity (VA), intraocular pressure (IOP), medication use for antiglaucoma, and postoperative complications.
Results: The mean follow-up time was 9.11 ± 10.49 months. The mean preoperative visual field deviation and VA were -28.01 ± 3.30 dB and 0.36 ± 0.37 log minimum angle of resolution unit, respectively. Postoperatively, the VA for over half (54.1%) of the eyes increased, 29.7% remained unchanged, and 16.2% worsened. The final IOP decreased significantly from 24.65 ± 8.61 to 14.81 ± 3.54 mm Hg. Glaucoma medication use also reduced from 1.46 ± 1.43 to 0.88 ± 1.18. The success rate was 48.6% for complete and 89.2% for qualified. IOP spikes (27.0%) and wipe-out (8.1%) were the most common postoperative complications. Vision recovered gradually in 5 of 6 wipe-out patients. One eye (1.4%) developed permanent vision loss with VA decreasing to hand motion.
Conclusion: Phaco-GSL appears safe and effective in treating advanced PACG cases with tubular vision or temporal field island. However, caution is warranted when considering this treatment option for patients at high wipe-out risk or those with high expectations for visual outcomes.
期刊介绍:
The Journal of Glaucoma is a peer reviewed journal addressing the spectrum of issues affecting definition, diagnosis, and management of glaucoma and providing a forum for lively and stimulating discussion of clinical, scientific, and socioeconomic factors affecting care of glaucoma patients.