Efficacy of goniosynechialysis for advanced chronic angle-closure glaucoma

PURPOSE: To evaluate the intraocular pressure (IOP)-lowering efficacy of goniosynechialysis (GSL) for advanced chronic angle-closure glaucoma (CACG) using a simplified slit-lamp technique. PATIENTS AND METHODS: Patients with CACG with one severely affected eye with best-corrected visual acuity below 20/200 and a mildly or functionally unaffected fellow eye were enrolled in this study. All patients underwent ophthalmologic examinations including measurement of visual acuity, best-corrected visual acuity, and IOP; biomicroscopy; specular microscopy; fundus examination; and gonioscopy followed by anterior chamber paracentesis and GSL for nasal peripheral anterior synechiae in the eye with severe CACG. RESULTS: Thirty patients (18 men, 12 women) were identified as having CACG with an initial mean IOP of 47.1 ± 6.7 mmHg (range 39–61 mmHg) in the severely affected eye. One week after GSL, the mean IOP of the treated eyes decreased to 19.3 ± 2.8 mmHg (range 14–26 mmHg) without antiglaucoma medication (average decrease 27.7 ± 6.5 mmHg; range 16–41 mmHg), which was significant (P < 0.00001) compared with baseline. After an average follow-up period of 36.6 ± 1.0 months (range 35–38 months), the mean IOP stabilized at 17.4 ± 2.2 mmHg (range 12–21 mmHg). The nasal angle recess did not close again in any one of the patients during the follow-up period. The average significant (P < 0.00001) decrease in corneal endothelial cell density in the treated eyes was 260 ± 183 cells/mm(2) (range 191–328 cells/mm(2)). CONCLUSIONS: Anterior chamber paracentesis and GSL lowers IOP in advanced CACG, though it may lead to mild corneal endothelial cell loss.