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Safety and efficacy of incisional goniotomy as an adjunct with phacoemulsification in primary angle-closure glaucoma.

PURPOSE
To evaluate the intraocular pressure (IOP)-lowering efficacy and safety of incisional goniotomy as an adjunct to phacoemulsification in primary angle-closure glaucoma (PACG) patients.


METHODS
In this prospective interventional case series, consecutive patients with PACG (high or borderline IOP) deemed fit for phacoemulsification were enrolled. Following phacoemulsification, incisional goniotomy was performed with or without goniosynechialysis. Patient demographic profile, clinical data, and adverse events, if any, were analysed during at least a 6-month follow-up period. Success was defined as IOP ≤ 18 mm Hg with or without medications.


RESULTS
Of 46 eyes (38 patients), 69.6% eyes were classified as having advanced glaucoma. Mean treated IOP decreased by 7.3±1 (SE) mmHg (95% CI: 5.2- 9.3) from 21.4±6.6 to 14.2±3.7 mmHg at mean duration of 11.7±5.5 months (6-22 months) postoperatively (P< 0.001; paired t test). There was 66.6% reduction in median number of hypotensive medications (P<0.001; Wilcoxon Signed rank test). Observed complications included hyphema (28%;13 eyes), IOP spike (6.5%; 3 eyes) and cyclodialysis (2.17%; 1 eye). High treated IOP and number of medications were significantly associated with failure in univariate analysis (p<0.05; Fisher exact test). The cumulative survival probability for qualified success at 22 months was 87.8%±0.07 (95% CI:0.65-0.96).


CONCLUSIONS
Incisional goniotomy as an adjunct with phacoemulsification resulted in a significant and sustained reduction in IOP along with decrease in number of glaucoma medications in chronic PACG eyes, irrespective of the disease stage.