Combined phacoemulsification and viscogoniosynechialysis in patients with refractory acute angle-closure glaucoma

PURPOSE: To evaluate the effectiveness of phacoemulsification and viscogoniosynechialysis in managing refractory acute angle-closure glaucoma (ACG) unresponsive to laser iridotomy and medical therapy. SETTING: Department of Ophthalmology, Khalili Hospital, Shiraz Medical University, Shiraz, Iran. METHODS: Eleven patients with acute ACG who did not respond to standard therapy and who had peripheral anterior synechia (PAS) of 270 degrees or less had phacoemulsification and viscogoniosynechialysis. After phacoemulsification, the anterior chamber was deepened with an ophthalmic viscosurgical device, which was then injected near the angle without touching any ocular structure to release the PAS. RESULTS: Eleven patients with a mean age of 58.9 years were included over a mean follow-up of 7.8 months. Preoperatively, the mean intraocular pressure (IOP) was 39.4 mm Hg and the mean number of antiglaucoma medications, 3.8. Postoperatively, the mean IOP decreased to 13.4 mm Hg (P = .003) and the mean number of medications, to 0.4 (P = .002). The mean logMAR visual acuity improved from 0.94 to 0.55 (P = .007). In 8 eyes (72.8%), IOP was controlled without antiglaucoma therapy. Of patients whose IOP was controlled with medication, 1 was on 3 medications and the others on 1 medication. In all patients except the one whose IOP was controlled by 3 medications, the previously occluded trabecular meshwork was exposed over 360 degrees on gonioscopy. CONCLUSION: Combined phacoemulsification and viscogoniosynechialysis was an effective and safe treatment for the management of refractory acute ACG that was unresponsive to laser iridotomy and medical therapy.