Phacoemulsification combined with goniosynechialysis for acute angle-closure glaucoma: impact of preoperative IOP status.

PRéCIS: Treatment of acute angle-closure glaucoma with phacoemulsification combined with goniosynechialysis significantly improves patients' visual acuity and reduce intraocular pressure; the preoperative condition has minimal influence on the treatment outcome. PURPOSE: The study aimed to treat acute angle-closure glaucoma and explore the structural differences of the anterior segment as well as the influence of persistent high intraocular pressure on surgical outcomes. METHODS: This retrospective case-control study included 120 patients (122 eyes) with acute angle-closure glaucoma, divided into two groups based on intraocular pressure two hours post-drug treatment: a normotensive group (21 mmHg or below; 54 subjects/55 eyes) and a hypertensive group (> 21 mmHg; 66 patients/67 eyes). Anterior segment structures, corneal endothelial cell density, and other parameters were systematically analyzed. All patients underwent phacoemulsification combined with goniosynechialysis. Statistical analysis employed independent-samples t-tests, Mann-Whitney U tests, and Wilcoxon signed-rank tests, as appropriate. RESULTS: There was no significant difference in the anterior segment structure between the two groups (P > 0.05) except for anterior chamber depth (t = -2.541, P = 0.012). Corneal endothelial cell density was significantly higher in the normotensive group than in the hypertensive group (Z = -0.399, P = 0.026).Postoperative visual acuity improved in both groups (Z = -8.663, P < 0.01), but no significant intergroup difference was observed (Z = -1.201, P = 0.23).Intraocular pressure decreased significantly in both groups (t = 25.901, P < 0.01). with a more pronounced reduction in the hypertensive group (Z = -3.387, P = 0.01). CONCLUSIONS: In medically treated acute angle-closure glaucoma, anterior chamber depth differed significantly between the normotensive and hypertensive groups ( P = 0.012), whereas no significant differences were observed in other anterior segment parameters (P > 0.05). Following phacoemulsification combined with goniosynechialysis, both visual acuity and intraocular improved. Preoperative persistent high intraocular pressure has no significant effect on surgical outcomes.