Evaluation of Adjunctive Ab-Interno Goniotomy in Chronic Angle-Closure Glaucoma

Overview

This study evaluates the efficacy of adjunctive ab-interno goniotomy during phacoemulsification with goniosynechialysis in chronic angle-closure glaucoma. Results indicate differences in qualified-failure-free survival and medication-free success rates over 24 months.

Background

Chronic angle-closure glaucoma (CACG) is a significant cause of irreversible blindness, especially in Asian populations. Phacoemulsification with goniosynechialysis (Phaco-GSL) is a common treatment, but its effectiveness in controlling intraocular pressure (IOP) can vary. The addition of adjunctive ab-interno goniotomy may improve aqueous outflow.

Data Highlights

Key Findings

• Adjunctive goniotomy was associated with higher 24-month qualified-failure-free survival compared to Phaco-GSL alone.
• Weighted hazard ratio for qualified failure was 0.475.
• Medication-free complete success rates were higher with adjunctive goniotomy (risk difference 0.291).
• Hyphema occurred more frequently in the goniotomy group.
• Predicted individualized benefit estimates varied and require external validation.

Clinical Implications

Adjunctive ab-interno goniotomy may provide different surgical outcomes in patients with chronic angle-closure glaucoma undergoing Phaco-GSL. The occurrence of hyphema should be noted.

Conclusion

Adjunctive goniotomy is associated with differences in surgical outcomes in chronic angle-closure glaucoma, but further validation of individualized benefit estimates is necessary.

Related Resources & Content

1. Frontiers in Medicine, 2026 -- Phacoemulsification with IOL implantation combined with goniosynechialysis and goniotomy in primary angle-closure glaucoma following failed trabeculectomy: short-term effectiveness and safety outcomes
2. Ophthalmology Management, 2014 -- Anterior-segment OCT in glaucoma management
3. Glaucoma Physician, 2022 -- Anterior-segment Imaging in Glaucoma
4. Ophthalmology Management, 2014 -- Assess narrow angle glaucoma with AS-OCT
5. Primary Angle-Closure Disease Preferred Practice Pattern® - Ophthalmology
6. JAMA Ophthalmology, 2019 -- Phacoemulsification Alone vs Phacoemulsification With Goniosynechialysis in Primary Angle-Closure Disease
7. PubMed -- Diagnostic criteria of anterior segment swept-source optical coherence tomography to detect gonioscopic angle closure
8. Primary Angle-Closure Disease Preferred Practice Pattern® - Ophthalmology
9. Phacoemulsification Alone vs Phacoemulsification With Goniosynechialysis in Primary Angle-Closure Disease
10. Diagnostic criteria of anterior segment swept-source optical coherence tomography to detect gonioscopic angle closure - PubMed