Phacoemulsification Combined with Goniosynechialysis and Goniotomy fzor Primary Angle-Closure Glaucoma: A Mini Systematic Review
DOI:
https://doi.org/10.37287/ijghr.v8i4.2308Keywords:
goniotomy, phacoemulsification, primary angle-closure glaucoma, visco-goniosynechialysisAbstract
Primary angle-closure glaucoma (PACG) is a major cause of irreversible blindness and is commonly associated with elevated intraocular pressure (IOP). Objective to evaluate the effectiveness and safety of combining phacoemulsification (PEI), goniosynechialysis (GSL) or visco-goniosynechialysis (VGSL), and goniotomy (GT) in the management of PACG. A mini systematic review was conducted using Google Scholar, PubMed, and ProQuest up to March 2025. Eligible studies evaluating combined PEI, GSL/VGSL, and GT in PACG patients were screened independently by two reviewers and analyzed descriptively. Five studies involving 534 eyes from 475 patients were included, comprising two retrospective case series, one randomized clinical trial, and two multicentre observational studies. Follow-up periods ranged from one week to 24 months. Across studies, the combined procedure consistently demonstrated significant reductions in IOP and glaucoma medication use, while reported complications were generally mild and self-limiting. Combined PEI, GSL/VGSL, and GT appears to be a safe and effective surgical option for PACG with coexisting cataract. This review contributes to the growing evidence supporting angle-based surgical interventions for improving IOP control and reducing medication burden in PACG.
References
Barkan, O. (1947). Goniotomy For Congenital Glaucoma. Journal of the American Medical Association, 133(8), 526. https://doi.org/10.1001/jama.1947.02880080018005
Dorairaj, S., & Tam, M. D. (2019). Kahook Dual Blade Excisional Goniotomy and Goniosynechialysis Combined With Phacoemulsification for Angle-closure Glaucoma: 6-Month Results. Journal of Glaucoma, 28(7), 643–646. https://doi.org/10.1097/IJG.0000000000001256
Dorairaj, S., Tam, M. D., & Balasubramani, G. K. (2021). Two-Year Clinical Outcomes of Combined Phacoemulsification, Goniosynechialysis, and Excisional Goniotomy For Angle-Closure Glaucoma. Asia-Pacific Journal of Ophthalmology, 10(2), 183–187. https://doi.org/10.1097/APO.0000000000000321
Ghadamzadeh, M., Karimi, F., Ghasemi Moghaddam, S., & Daneshvar, R. (2022). Anterior Chamber Angle Changes in Primary Angle-closure Glaucoma Following Phacoemulsification Versus Phacotrabeculectomy: A Prospective Randomized Clinical Trial. Journal of Glaucoma, 31(3), 147–155. https://doi.org/10.1097/IJG.0000000000001977
Gupta, S., Sethi, A., Yadav, S., Azmira, K., Singh, A., & Gupta, V. (2021). Safety and efficacy of incisional goniotomy as an adjunct with phacoemulsification in primary angle-closure glaucoma. Journal of Cataract and Refractive Surgery, 47(4), 504–511. https://doi.org/10.1097/j.jcrs.0000000000000481
Husain, R., Do, T., Lai, J., Kitnarong, N., Nongpiur, M. E., Perera, S. A., Ho, C. L., Lim, S. K., & Aung, T. (2019). Efficacy of Phacoemulsification Alone vs Phacoemulsification With Goniosynechialysis in Patients With Primary Angle-Closure Disease. JAMA Ophthalmology, 137(10), 1107. https://doi.org/10.1001/jamaophthalmol.2019.2493
Lin, F., Zhang, Y., Zhu, X., Yu, P., Fan, S., Lv, A., Li, X., Tang, L., Zhang, Y., Tang, G., Yan, X., Lu, L., Xiao, M., Yuan, H., Song, W., Zhou, M., Zhao, X., Nie, X., Liao, M., … Zhang, X. (2024). Impact of Peripheral Anterior Synechiae on the Outcome of Combined Phacoemulsification, Goniosynechialysis, and Goniotomy for Primary Angle Closure Glaucoma and Cataract: A Multicenter Observational Study. Journal of Glaucoma, 33(8), 587–593. https://doi.org/10.1097/IJG.0000000000002435
Shokoohi-Rad, S., Karimi, F., Zarei-Ghanavati, S., & Tireh, H. (2021). Phacoemulsification, visco-goniosynechialysis, and goniotomy in patients with primary angle-closure glaucoma: A comparative study. European Journal of Ophthalmology, 31(1), 88–95. https://doi.org/10.1177/1120672119879331
Singh, K., Aggarwal, H., & Bhattacharyya, M. (2024). Phacoemulsification in angle-closure glaucoma: A 360° evaluation. Indian Journal of Ophthalmology, 72(9), 1275–1279. https://doi.org/10.4103/IJO.IJO_1701_23
Song, Y., Song, W., Zhang, Y., Zhang, H., Xiao, M., Zhao, X., Lv, A., Yan, X., Lu, P., Zhu, X., Gao, X., Hu, K., Zhang, Y., Liang, X., Zhang, X., Tang, G., Lu, L., Zhou, M., Fan, S., … Zhang, X. (2021). Efficacy and safety of phacotrabeculectomy versus phacogoniotomy in advanced primary angle-closure glaucoma: study protocol for a multicentre non-inferiority randomised controlled trial (PVP Study). BMJ Open, 11(12), e056876. https://doi.org/10.1136/bmjopen-2021-056876
Song, Y., Zhang, Y., Li, F., Zhang, Y., Lin, F., Lv, A., Li, X., Lu, P., Xiao, M., Zhang, H., Yan, X., Zhu, X., Song, W., Zhao, X., Gao, X., Hu, K., Liang, X., Zhang, X., Wang, Z., … Zhang, X. (2022). One-Year Results of a Multicenter Study: Intraocular Pressure–Lowering Effect of Combined Phacoemulsification, Goniosynechialysis, and Goniotomy for Cases of Advanced Primary Angle-Closure Glaucoma With Cataract. Asia-Pacific Journal of Ophthalmology, 11(6), 529–535. https://doi.org/10.1097/APO.0000000000000579
Yao, L., Yang, X., Jia, S., Wang, W., Yang, X., & Bai, H. (2023). Combined Surgery Versus Phacoemulsification Alone for Patients with Primary Angle Closure Glaucoma: A meta-analysis. Seminars in Ophthalmology, 38(5), 457–464. https://doi.org/10.1080/08820538.2022.2148114
Zhang, N., Wang, J., Chen, B., Li, Y., & Jiang, B. (2021). Prevalence of Primary Angle Closure Glaucoma in the Last 20 Years: A Meta-Analysis and Systematic Review. Frontiers in Medicine, 7. https://doi.org/10.3389/fmed.2020.624179
Zhang, Y., Yu, P., Zhang, Y., Sugihara, K., Zhu, X., Zhang, Y., Yang, X., Li, X., Liu, Y., Zhang, H., Yan, X., Zhang, H., Lin, F., Song, Y., Gao, X., Yuan, H., Tang, G., Zhou, W., Fan, S., … Zhang, X. (2023). Influence of Goniotomy Size on Treatment Safety and Efficacy for Primary Open-Angle Glaucoma: A Multicenter Study. American Journal of Ophthalmology, 256, 118–125. https://doi.org/10.1016/j.ajo.2023.08.002
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Indonesian Journal of Global Health Research
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
