Zefeng Yang, Bin Xie, Jiangang Xu, Zhao, Ping, 1955-, Xiaoyan Li, Nan Zhang, Can Wang, Xiaomin Zhu, Xiangxiang Ye, Tingli Wen, Xiaohua Pan, 迪 Di 王 Wang, Hanying Fan, Hengli Zhang, Jing Zhu, Xiaohuan Zhao, Zhihong Zhang, Xin Zhang, Xin Zhang, Yawen Feng, Xiang Mo, Xuelian Tian, Fei Li, Yunhe Song, Fengbin Lin, Zhixuan Wang, Zige Fang, Fengqi Zhou, Dilimulati Xiaokaiti, Minwen Zhou, Yangfan Yang, Jingjing Huang, Juan Guo, Guangxian Tang, Liuzhi Zeng, Hong Ju, Hongyang Zhang, Ning Fan, Li Tang, Yongjun Qi, Lin Xie, Ling Yu, Sujie Fan, Min Ke, Xiulan Zhang, Xiulan Zhang
PURPOSE: To evaluate the visual preservation, safety, and surgical outcomes of phacogoniotomy (phacoemulsification combined with or without goniosynechialysis and goniotomy) in patients with end-stage glaucoma. METHODS: This multicenter retrospective study included 134 eyes of 128 patients (92 primary angle-closure glaucoma [PACG] and 42 primary open-angle glaucoma [POAG]) with end-stage glaucoma (defined as inability to perform perimetry or visual acuity ≤ 20/200). Patients underwent phacogoniotomy and were followed ≥ 12 months. Main outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), medication burden, and complications, with specific attention to the "wipe-out" phenomenon. RESULTS: At a mean follow-up of 19.2 ± 8.0 months, no cases of "wipe-out" (sudden, immediate, irreversible central vision loss) occurred. BCVA improved in 63.1% of eyes and remained stable in 30.3%. The mean IOP decreased significantly from 31.4 ± 9.7 mm Hg to 14.1 ± 3.3 mm Hg (P < 0.001) and mean number of medications dropped from 2.2 ± 1.4-0.6 ± 1.0 (P < 0.001). Complete success rate was 67.9% overall, with 76.1% for PACG and 50.0% for POAG (P = 0.005). Qualified success rate was 97.0% overall, with 96.7% for PACG and 97.6% for POAG (P = 0.695). The most common complications were transient hyphema (11.2%) and IOP spike (3.7%). CONCLUSIONS: In end-stage glaucoma, phacogoniotomy is a safe and effective procedure that significantly lowers IOP while preserving or improving vision in > 90% of cases. The procedure may reduce the risk of "wipe-out" associated with traditional filtration surgery and appears particularly effective in eyes with angle-closure mechanisms.