AIM: To observe the safety and efficacy of phacoemulsification combined with goniosynechialysis in treatment of primary angle-closure glaucoma(PACG)with intraocular pressure out of control after trabeculectomy.

METHODS: We retrospectively reviewed 31 cases(32 eyes)of acute or chronic PACG with uncontrolled intraocular pressure from June 2015 to April 2019. The history of trabeculectomy was 3mo to 12a. All of them were complicated with different degrees of cataract. Phacoemulsification combined with intraocular lens implantation and goniosynechialysis were performed in all patients. The patients were followed up for 6mo. The IOP, the best corrected visual acuity(BCVA), the depth of central anterior chamber and the peripheral anterior synechia(PAS)of anterior chamber angle were observed preoperatively and 1, 3 and 6mo postoperatively. The corneal endothelial cell count and the thickness of the retinal nerve fiber layer(RNFL)were observed 6 months after the operation. The complications during and after operation were observed.

RESULTS: The IOP was significantly decreased on 1wk, 1, 3, 6mo postoperative(14.38±3.04, 18.26±3.12, 15.21±2.84, 15.42±3.09mmHg)compared with preoperative(36.52±12.26mmHg)(P<0.01). The BCVA(LogMAR)(0.241±0.148)was increased postoperative after 6 mo compared with preoperative(0.678±0.297). The depth of central anterior chamber was increased on 1, 3, 6mo postoperative(4.18±0.22, 4.21±0.24, 4.16±0.25mm)compared with preoperative(1.45±0.25mm). All of above observation indexes was significantly different from that of preoperation(P<0.01). The angle of anterior chamber was widened and the range of PAS was reduced. The PAS did not increase after 3mo. There was no statistical difference between preoperative and postoperative about the corneal endothelial cells count and the mean or the four quadrant RNFL thickness(P>0.05). Corneal edema in 7 eyes and anterior chamber inflammatory exudation in 3 eyes disappeared within 7d after treatment. The IOP of 3 patients(3 eyes)with chronic PACG was 21-30mmHg which was controlled by 1 to 3 anti-glaucoma eye drops.

CONCLUSION: Phacoemulsification combined with goniosynechialysis is a safe and effective method in the treatment of PACG combined with cataract with intraocular pressure out of control after trabeculectomy.