Purpose To evaluate changes of anterior chamber angle (ACA) by anterior-segment optical coherence tomography (AS-OCT) in patients with primary angle-closure glaucoma (PACG) with synechial angle closure and cataract following  phacoemulsification with posterior chamber intraocular lens implantation combined with goniosynechialysis (phaco-GSL).
Methods  Patients with primary angle closure glaucoma with more than 180° synechial angle closure and intraocular pressures (IOP) higher than 21 mmHg or normal on maximally tolerated medications, and concurrent cataract, underwent phacoemulsification with posterior chamber intraocular lens implantation combined with goniosynechialysis. Six cross-segments images of anterior chamber angle were obtained by AS-OCT before surgery and 1, 2 weeks and 1 month after phaco-GSL. The AS-OCT images were analyzed for the following measurements using customized software: angle opening distance (AOD) at 500 and 750 μm from the scleral spur; trabecular-iris space area (TISA) at 500 and 750 μm; angle recess area (ARA) at 500 and 750 μm, and scleral spur angle. In addition, pre- and post- intraocular pressures (IOP), logMAR visual acuity, anterior chamber depth, as well as related complications were evaluated.
Results Twelve patients, with an average age of 71.60 ± 7.81 years, were recruited. All parameters (AOD500, AOD750, TISA500, TISA 750, ARA500, ARA 750, and scleral spur angle) of every cross-segment of anterior chamber angle measured by AS-OCT increased significantly after phaco-GSL (p<0.001). The mean preoperative intraocular pressure was 22.7 ± 7.99 mm Hg with average number of anti-glaucoma medications as 2.50±0.97. After surgery, the average postoperative intraocular pressure at the most recent follow-up was 16.7 ± 1.64 mm Hg without any anti-glaucoma medication. Compared with preoperative values, there were significant differences in logMAR visual acuity (from 1.29 to 0.52) and anterior chamber depth (from 2.25 to 3.71) (p<0.001). None of the patients developed cornea astigmatism, central cornea thickness, optic disc or visual field damage attributable to angle closure.
Conclusion AS-OCT provides quantitative and reproducible assessment of ACA after phaco-GSL. Phaco-GSL is an effective and safe surgical procedure for treating primary angle-closure glaucoma with synechial angle closure and cataract.