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Aqueous outflow facility after phacoemulsification with or without goniosynechialysis in primary angle closure: a randomised controlled study
  1. Ian A Rodrigues,
  2. Pouya Alaghband,
  3. Laura Beltran Agullo,
  4. Elizabeth Galvis,
  5. Stephanie Jones,
  6. Rahat Husain,
  7. K Sheng Lim
  1. Department of Ophthalmology, St Thomas’ Hospital, London, UK
  1. Correspondence to K Sheng Lim, Department of Ophthalmology, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH UK; shenglim{at}


Background Goniosynechialysis (GSL) to remove peripheral anterior synechiae (PAS) alongside standard cataract surgery has potential theoretical advantages, Published randomised trials, however, have not shown conclusive functional benefits and aqueous outflow changes following GSL are unknown. This study aimed to compare electronic Shiøtz tonographic aqueous outflow facility (TOF) following phacoemulsification with or without GSL in patients with primary angle closure (PAC) and PAC glaucoma. Secondary outcomes were changes in intraocular pressure (IOP) and use of glaucoma medications.

Methods Prospective randomised pilot study of 26 patients on glaucoma medication, with ≥90° PAS and significant lens opacity. Patients were randomised 1:1 to receive phacoemulsification with intraocular lens (IOL) implantation only (phaco) or phacoemulsification with IOL plus GSL (phaco-GSL).

Results Fourteen patients were randomised to phaco-GSL and 12 to phaco alone. TOF increased with phaco-GSL from 0.099±0.07 μL/min/mm Hg to 0.194±0.07, μL/min/mm Hg, p=0.0006, while the phaco group showed no significant change. IOP reduced in both groups, but reduced significantly more following phaco-GSL (46.0%) compared with phaco alone (27.6%, p=0.04). Medication use and extent of PAS only reduced with phaco-GSL, from 0.923±0.86 to 0.384±0.18 medications, p=0.0279, and from 249.2±83.4 to 110.8±53.9° PAS, 6 months postoperatively. No serious adverse events occurred in either group.

Conclusions Eyes randomised to both surgical groups had similar and good outcomes at 6 months in this pilot study. However, only eyes undergoing GSL combined with standard phacoemulsification had significantly increased TOF, reduced glaucoma medication dependence and PAS postoperatively. GSL should therefore be considered in such patients.

Trial registration number: NCT00719290, Results.

  • Glaucoma
  • Angle
  • Treatment Surgery
  • Aqueous humour
  • Lens and zonules

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  • Contributors IAR: data analysis/interpretation of data, drafting and revising of work, and final approval. PA: study conception, design, data acquisition, interpretation of data, drafting and revising of work, and final approval. LBA: study conception, design, data acquisition and drafting of work. EG: study conception, design, data acquisition and data analysis. SJ: study conception, design and data acquisition. RH: study conception, design, data acquisition and drafting of work. KSL: study conception, design, interpretation of data, drafting and revising, and final approval.

  • Funding KSL is supported by the National Institute of Health Research, Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust.

  • Competing interests None declared.

  • Ethics approval Guy's & St Thomas’ Research Ethics Committee. Ethics approval for this prospective study was obtained from the local research ethics committee. The research conformed to the recommendations adopted by the Helsinki declaration.

  • Patient consent A patient information leaflet was provided at the initial contact and signed consent obtained before the measurements and surgery.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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