Efficacy and safety of PEI combined with goniosynechialysis and goniotomy in the treatment of APACG

Objective To evaluate the efficacy and safety profile of combined phacoemulsification with intraocular lens implantation (PEI), goniosynechialysis (GSL), and goniotomy (GT) in managing acute primary angle-closure glaucoma (APACG) with coexisting cataract. Methods This prospective case series enrolled 41 eyes from 39 APACG patients (mean age 66.95±8.51 years) at Fuzhou Eye Hospital (2022-2024). All subjects underwent triple surgery (PEI+GSL+GT). Primary endpoints included intraocular pressure (IOP) reduction, anti-glaucoma medication(AGM) burden, and complications over 36 months. Surgical success was defined as IOP 5-21 mmHg with ≥20% reduction from the baseline without vision-threatening complications. Statistical analyses employed paired t-tests and Wilcoxon signed-rank tests.Written informed consent was obtained from all 39 participants prior to enrollment, including specific authorization for surgical video recording and anonymized data publication. Results The study demonstrated significant efficacy of PEI+GSL+GT in controlling IOP and reducing AGM in APACG patients. At 36 months postoperatively, the complete success rate was 53.8% (95% CI: 42.5%–65.1%), while the qualified success rate(IOP control with ≤2 medications) reached 71.6% (95% CI: 61.3%–81.9%). Mean IOP decreased from 38.52±10.56 mmHg preoperatively to 17.12±4.54 mmHg at 36 months (Δ55.6%, P < 0.001), paralleled by a 71.8% reduction in AGM(from 3.02±0.6 to 0.85±0.8 agents, P < 0.001). Postoperative complications included transient IOP elevation (26.42%, 14/53), corneal edema (15.09%, 8/53), and anterior chamber hemorrhage (11.32%, 6/53), all managed conservatively without sight-threatening events or secondary surgical interventions Conclusions PEI+GSL+GT demonstrates significant reductions in intraocular pressure and medication burden in acute primary angle-closure glaucoma (APACG), whilst exhibiting a superior safety profile in comparison with conventional trabeculectomy. This minimally invasive approach integrates triple therapeutic mechanisms, namely cataract extraction, peripheral anterior synechiolysis (PAS) and trabecular meshwork excision, to reconstruct physiological outflow pathways. This represents a safer surgical alternative. It is recommended that further large-scale multicentre randomised trials are conducted in order to validate the efficacy of the treatment in the APACG and to standardise optimised surgical protocols.