Three-year outcomes of combined surgical peripheral iridectomy, goniosynechialysis and goniotomy for advanced primary angle-closure glaucoma: a multicentre study
In brief
Combined glaucoma surgery lowers eye pressure 41% over three years
In a prospective study of 70 eyes with advanced angle-closure glaucoma and no cataract, average eye pressure fell from 29.4 to 16.4 mm Hg, while medication use dropped 66%; 84% met the study's definition of qualified surgical success at three years. Visual field results stayed stable, but cataract progression caused significant vision loss in 21% of eyes, so longer-term outcomes remain important.
- Journal
- The British journal of ophthalmology (Q1)
- Published
- 5 October 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 4, Very Low (CEBM 4)
- Authors
- Fengbin Lin, Li Tang, Xiaomin Zhu, Hengli Zhang, Tingli Wen, Guangxian Tang, et al.
- PMID
- 42833871
- DOI
- 10.1136/bjo-2026-329527
Why clinicians should know about it
- Picked for Ophthalmology (paper of the day, 8 October 2026): Combined SPI+GSL+GT provides sustained IOP reduction, stable visual function
Abstract
AIMS: To assess the 3-year efficacy and safety of combined surgical peripheral iridectomy (SPI), goniosynechialysis (GSL) and goniotomy (GT) for advanced primary angle-closure glaucoma (PACG) without cataract. METHODS: This was a multicentre prospective observational study with extended follow-up. We enrolled advanced PACG without cataract patients who underwent combined SPI+GSL+ GT and completed 36-month follow-up. Key outcomes included changes in intraocular pressure (IOP), best-corrected visual acuity (BCVA), usage of anti-glaucoma medications, surgical success rates, progression of peripheral anterior synechiae (PAS), endothelial cell density, visual field (VF) mean deviation (MD) and long-term postoperative complications. RESULTS: A total of 70 eyes from 58 patients were included in the final analysis. Baseline mean IOP (29.4±8.1 mm Hg) decreased to 16.4±4.01 mm Hg at 36 months (40.7±18.8% reduction, p<0.001), with anti-glaucoma medications declining from 2.0±1.4 to 0.7±0.9 (p<0.001), representing a 65.7% reduction in required medications postoperatively. At the 3-year follow-up, the cumulative complete and qualified success rates were 54.3% and 84.3%, respectively. Median BCVA worsened slightly (0.00 vs 0.10 logarithm of the minimum angle of resolution, p<0.001); 21.4% of eyes had significant vision loss (≥2 Snellen lines), attributable to cataract progression. MD of VF remained stable (p=0.217). Main late complications were cataract requiring surgery (n=10) and persistent PAS (n=11), with no vision-threatening events. Older age correlated with higher 3-year surgical success (p<0.05). CONCLUSIONS: Combined SPI+GSL+GT provides sustained IOP reduction, stable visual function, and a favourable safety profile over 3 years, supporting its role as a reliable long-term treatment for advanced PACG without cataract.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.