Real World Comparison Of Combined Phacoemulsification And Viscogonioplasty Versus Laser Peripheral Iridotomy In The Management Of Treatment Naïve Primary Angle Closure

Real world comparison of combined phacoemulsification and viscogonioplasty versus laser peripheral iridotomy in the management of treatment naïve Primary Angle Closure

To compare the outcomes of phacoemulsification combined with viscogonioplasty (phaco-VGP) and laser peripheral iridotomy (LPI) on a cohort of treatment naïve patients with primary angle closure (PAC)

Retrospective data was retrieved from electronic medical records. Subjects involved were patients newly diagnosed with PAC between 2015 and 2019, with no evidence of glaucoma or previous treatment, who have been offered either LPI or phaco-VGP as a treatment option. Exclusion criteria from statistical analysis comprises any other eye comorbidity, poor or insufficient data. Follow up assessments postoperatively, have been carried out at 2 weeks, 3 months, 6 months, 12 months and 24 months. Primary outcomes measured were intraocular pressure (IOP) reduction and number of anti-glaucoma agents. Secondary outcomes consisted of best corrected visual acuity (BCVA), mean deviation (MD) on Humphrey Field Analyser and postoperative complications. 

Fifty-six and 109 eyes underwent phaco-VGP and LPI respectively between 2015 and 2019. IOP reduction observed was 23.04% and 6.29% in the phaco-VGP and LPI respectively. BCVA improved from 67.29 ± 12.11 letters to 77.93 ± 7.20 letters in phaco-VGP group, and varied from 79.16 ± 8.53 letters to 79.87 ± 8.67 in LPI group. The MD variation observed was -6.28 dB to +0.51 dB in phaco-VGP group and -4.7 dB to 2.65 dB in LPI group. The number of anti-glaucoma agents reduced from 1.6 ± 0.2 to 0.5 ± 0.1 in phaco-VGP group and 1.2 ± 0.1 to 1.1 ± 0.1 in LPI group. Postoperative uveitis was the most common complication in phaco-VGP group (19.6%). In LPI group, IOP spike was the most frequent complication occurring in 18.35 % of cases.

In our cohort, phaco-VGP provided a significantly better outcome in terms of BCVA, IOP, number of anti-glaucoma agents and MD compared to LPI at two years. Despite LPI carries an overall greater safety profile, no serious adverse events were registered in either groups.