Surgical Efficacy After Viscogonioplasty in Primary Angle Closure Disease with Different Mechanisms.

Precis: Non-pupillary block mechanisms are associated with larger postoperative peripheral anterior synechiae (PAS) extent at 1-year follow-up compared to pupillary block mechanisms in primary angle-closure disease (PACD).

Purpose: To evaluate the impact of preoperative angle-closure mechanisms on surgical outcomes of phacoemulsification and intraocular lens implantation (PEI) combined with VGP in PACD patients with cataracts.

Patients and methods: This prospective cohort study enrolled 56 patients (68 eyes) with PACD and cataracts. Participants were classified into pupillary block (PB) and non-pupillary block (Non-PB) groups based on the anatomical characteristics of angle closure shown in preoperative ultrasound biomicroscopy imaging. Primary outcomes included peripheral anterior synechiae (PAS) extent, intraocular pressure (IOP), and number of IOP-lowering medications over a 12-month follow-up period.

Results: Both groups showed significant reductions in PAS extent at the end of surgery compared to the baseline. At 6 and 12 months postoperatively, the Non-PB group exhibited significantly larger PAS extent compared to the PB group (P=0.025 and P=0.017, respectively). Both groups demonstrated significant IOP reduction and decreased use of IOP-lowering medications postoperatively, with no significant differences between groups. The overall complete and qualified success rates at 12 months were 71.6% and 98.5%, respectively, with no significant difference between groups.

Conclusions: Non-PB mechanisms are associated with larger postoperative PAS extent at 1-year follow-up compared to PB mechanisms, emphasizing the importance of comprehensive preoperative angle-closure mechanisms assessment in predicting and potentially minimizing PAS progression for enhanced long-term surgical efficacy in PACD treatment.