Postoperative Changes After Phacoemulsification with Posterior Intraocular Lens Implantation Combined with Goniosynechialysis in Patients with Different Axial Lengths

Abstract Background: With the aging of the global population, the incidence of primary angle-closure glaucoma (PACG) or primary angle closure (PAC) with concomitant cataracts has been increasing. We aimed to compare the corneal higher-order aberrations, refractive error and ocular biological parameters changes after phacoemulsification with posterior intraocular lens implantation combined with goniosynechialysis (Phaco-IOL-GSL) was performed in PACG or PAC patients with concomitant cataracts and different axial lengths. Methods: 83 eyes of 69 patients in cataracts with PACG or PAC were divided into two groups according to the axial length (AL): the short (AL ≤ 22.5 mm) and normal axial group (22.5 < AL ≤ 24.5 mm). The intraocular pressure (IOP) and best-corrected visual acuity (BCVA) were measured before surgery and 1-day, 1-week, 1-month, 3-month, 6-month, 12-month after surgery. The corneal higher-order aberrations, antiglaucoma medications, visual fields, refractive diopter and other ocular biological parameters were measured before surgery and at the last follow-up. The difference between the two groups was assessed after surgery. Results: Compared with the baseline, the BCVA significantly improved, while IOP was decreased in both groups (P < 0.01). Both anterior and total cornea HOAs and Z (3,-3) were increased in both groups (P < 0.05 and P < 0.05, respectively) and the larger increments in Z (3,-3) were found in normal axial group. The anterior chamber depth (ACD) and the AL were increased in both groups after Phaco-IOL-GSL ( P< 0.01 and P < 0.01, respectively); however, no difference was found between two groups (P = 0.191, P = 0.066). The refractive outcomes were significantly different in both groups (P = 0.029), and a slight shift towards hyperopia was observed in normal axial group (P = 0.002). Correlation analysis found that refractive error was positively correlated with increments in ACD (r = 0.373, P = 0.001) and decrements in AL (r = 0.331, P = 0.002). Conclusions: Phaco-IOL-GSL is an effective surgery for cataract patients with PACG or PAC. After surgery, anterior and total cornea Z (3, -3) varied with different AL at one-year follow-up. The refractive errors such as hyperopic shifts increased when the ACD was increased, and AL was decreased after surgery, especially in patients with normal axial lengths.