Goniosynechialysis Combined with Phacoemulsification for Managing Nanophthalmos

Overview

This study evaluates the efficacy of phacoemulsification combined with goniosynechialysis (Phaco + IOL + GSL) in managing nanophthalmos complicated by secondary angle-closure or angle-closure glaucoma. Results from 20 cases indicate that this approach is feasible and may provide a simpler alternative to more complex surgical interventions.

Background

Nanophthalmos is a rare congenital condition that poses significant risks for complications such as angle-closure glaucoma. Traditional filtering surgeries often lead to severe complications in these patients, necessitating alternative management strategies. The combination of phacoemulsification and goniosynechialysis offers a less invasive option that may improve outcomes in this challenging population.

Data Highlights

This study included 20 eyes of 20 patients diagnosed with nanophthalmos and secondary angle-closure. All patients underwent Phaco + IOL + GSL, with a follow-up period of at least 6 months.

Key Findings

• Phaco + IOL + GSL was performed on 20 eyes with a mean axial length of less than 20 mm.
• 18 eyes had glaucomatous optic neuropathy, while 2 had angle closure without glaucomatous damage.
• Combined procedures showed better intraocular pressure control and fewer complications compared to traditional filtering surgeries.
• Goniosynechialysis effectively reopened the aqueous outflow pathway, improving the management of angle-closure complications.
• The technique was associated with a shorter operative time and reduced surgical trauma compared to more complex procedures.

Clinical Implications

The findings suggest that Phaco + IOL + GSL can be a viable option for patients with nanophthalmos and secondary angle-closure, potentially reducing the risk of complications associated with more invasive surgeries. Surgeons may consider this approach as part of a stepwise management strategy for similar cases.

Conclusion

Phacoemulsification combined with goniosynechialysis presents a promising, less invasive alternative for managing angle-closure complications in patients with nanophthalmos. Further studies are warranted to confirm long-term outcomes.

Related Resources & Content

1. Yalvac et al., 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. Conner et al., Glaucoma Physician, 2021 -- A Stepwise Approach to Cases on the Angle-closure Spectrum
3. Frontiers in Ophthalmology, 2026 -- Combined phacoemulsification and angle filtering procedures versus phacoemulsification with clinical outcomes in primary glaucoma coexisting with cataracts: a meta-analysis of randomized controlled trials
4. American Academy of Ophthalmology, 2025 -- Primary Angle-Closure Disease Preferred Practice Pattern®
5. glaucoma physician — Management of the Primary Angle-closure Suspect
6. Efficacy of Phacoemulsification Alone vs Phacoemulsification With Goniosynechialysis in Patients With Primary Angle-Closure Disease: A Randomized Clinical Trial
7. Risk factors for glaucoma in nanophthalmos – a systematic review and meta-analysis
8. Primary Angle-Closure Disease Preferred Practice Pattern® - PubMed