Combined Phacoemulsification, Synechiolysis without Gonioprism Lens and Intracameral Tissue Plasminogen Activator Injection for Angle-Closure Glaucoma

Seok Ho Cho; Chang Won Kee

doi:10.3341/jkos.2015.56.6.931

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Cho and Kee: Combined Phacoemulsification, Synechiolysis without Gonioprism Lens and Intracameral Tissue Plasminogen Activator Injection for Angle-Closure Glaucoma

Original Article

J Korean Ophthalmol Soc 2015;56(6):931-937.

Published online: 7 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.6.931

Combined Phacoemulsification, Synechiolysis without Gonioprism Lens and Intracameral Tissue Plasminogen Activator Injection for Angle-Closure Glaucoma

Seok Ho Cho, MD, Chang Won Kee, MD, PhD

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Chang Won Kee, MD, PhD Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea, Tel: 82-2-3410-3569, Fax: 82-2-3410-0029 E-mail: ckee@skku.edu

Received 21 November 201419 December 2014 Accepted 23 April 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

In this study we evaluated the safety and efficacy of combined phacoemulsification and synechiolysis without aid of gonioprism lens and intraoperative intracameral tissue plasminogen activator (tPA) injection for angle-closure glaucoma.

Methods

The method used in this study was synechiolysis with Kuglen hook without aid of gonioprism lens and intraoperative intracameral tPA injection following cataract surgery.

Results

A total of 20 patients with a mean age of 71.4 ± 5.4 years were treated. Mean follow-up time was 31.3 ± 24.3 months. Mean preoperative and last visit intraocular pressures (IOPs) were 21.70 ± 9.50 mm Hg and 12.40 ± 2.30 mm Hg, respectively (p < 0.0001). The mean number of glaucoma medications decreased from 2.40 to 0.30 (p < 0.0001). IOP was maintained below 16 mm Hg in all cases. No significant intraoperative and postoperative complications, hyphema, or fibrin reaction occurred.

Conclusions

Combined phacoemulsification and peripheral anterior synechiolysis with Kuglen hook without aid of gonioprism lens and intraoperative intracameral tPA injection is an effective and safe surgical procedure.

Keywords: Angle-closure glaucoma, Fibrin reaction, Synechiolysis, Tissue plasminogen activator

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Figure 1.

The sequential images during synechialysis.

Figure 2.

Baseline and postoperative intraocular pressure (IOP) trend.

Figure 3.

Compared with preoperative anterior segment optical coherence tomography (OCT) image (A), postoperative image (B) showing deepening of anterior chamber depth.

Table 1.

General characteristic of patients

Variables	Description
Age (years)	71.4 ± 5.4
Gender (n)
Male	2
Female	18
Mean follow up (months)	31.3 ± 24.3
Preoperative BCVA	0.25 ± 0.18
Baseline anterior chamber depth (mm)	2.26 ± 0.25
Baseline axial length (mm)	23.17 ± 2.28
Baseline lens thickness (mm)	5.18 ± 0.34

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity.

Table 2.

Changes of IOP and glaucoma medication after surgery

IOP (mm Hg)
Preoperative IOP	21.70 ± 9.50
Postoperative IOP	12.40 ± 2.30
IOP change	9.30 ± 8.99 (p < 0.0001)^*
No. of glaucoma medication
Preoperative	2.40 ± 0.82
Postoperative	0.30 ± 0.57
Change	2.10 ± 1.07 (p < 0.0001)^*

Values are presented as mean ± SD.

IOP = intraocular pressure.

^* The difference of preoperative and postoperative value was assessed by Wilcoxon signed rank test.

Table 3.

Comparison of results with studies on combined phacoemulsification with goniosynechiolysis among angle-closure glaucoma

	Preoperative IOP (mm Hg)	Postoperative IOP (mm Hg)	Preoperative glaucoma medications	Postoperative glaucoma medications	Mean follow up (months)
Razeghinejad and Rahat³³ (n = 56)	20.9	14.8	2.7	1.0	9
Varma et al³⁴ (n = 29)	27.4	12.2	14% were on 1 medication		7
White et al¹⁷ (n = 34)	23.3	16.1	3.3	1.7	24
Present study (n = 20)	21.7	12.4	2.4	0.3	37.8

IOP = intraocular pressure.

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