AIM: To explore whether the drainage angle could be reopened by surgery in patients with severe acute angle-closure glaucoma at “the greatest degree” of angle closure, and to study the treatment methods, such as double-paracentesis, phacoemulsification combined with goniosychialysis, and the effectiveness.

METHODS: Retrospective observational case series. From November 2008, to November 2015, there were 33 patients with severe acute angle-closure glaucoma and 360° angle closure. Drug treatment showed no effect on them, so initial double-paracentesis(anterior chamber paracentesis combined with vitreous paracentesis)was applied. Then, either phacoemulsification combined with goniosychialysis or trabeculectomy surgery was performed after 7-14d, which was chosen based on the result of gonioscope during the surgery. The intraocular pressure, angle changes, and complications were observed. The follow-up period was 6mo to 3a.

RESULTS: Of 33 participants enrolled, 32 had normal intraocular pressure after “double-paracentesis”(2 had normal intraocular pressure after laser peripheral iridotomy). The mean intraocular pressure was significantly reduced from 53.4±10.7mmHg to 16.9±13.2mmHg(t=9.21,P<0.001)by applying “double-paracentesis”, and 1 still had higher intraocular pressure. The mean intraocular pressure(16.7±4.8mmHg)was 0.2mmHg lower after phacoemulsification than after “double-paracentesis” while there was no significant difference(t=0.38,P>0.05). One patient had abnormal intraocular pressure until 30d after phacoemulsification. Every participant had 360° angle closed before “double-paracentesis”, 32 patients had opened angle(mean 131.8°±111.3°)after “double-paracentesis” and mean(228.6°±108.3°)during phacoemulsification, and mean(234.6°±107.2°)at 3mo after phacoemulsification. There was a significant difference between the post-paracentesis and intraoperative values(t=4.52, P<0.001). There was no difference between the intraoperative and postoperative values(t=0.46, P>0.05). No patients had serious adverse events.

CONCLUSION: For the “maximum degree” angle closure of severe acute angle-closure glaucoma, “double-paracentesis” combined with phacoemulsification can be chosen to open the angle gradually, and reduce intraocular pressure in vast majority of patients.