Modular surgical approach for angle-closure glaucoma secondary to nanophthalmos

To explore and summarize outcomes of a modular surgical approach for the personalized management of angle-closure glaucoma (ACG) secondary to nanophthalmos.

This was a retrospective interventional case series involving consecutive patients with nanophthalmos and ACG. All patients were treated with a modular surgical approach tailored to their specific disease characteristics, which included the following surgical combinations: Procedure Ⅰ [phacoemulsification (phaco)+goniosynechialysis (GSL)], Procedure Ⅱ [Procedure Ⅰ +irido-zonulo-hyaloid-vitrectomy (IZHV)], Procedure Ⅲ [phaco +IZHV+Ahmed glaucoma valve (AGV) implantation], and Procedure Ⅳ (Procedure Ⅲ+scleral window creation).

A total of 92 eyes from 62 patients were enrolled, with a median age of 52 (range: 23-72)y and a median axial length of 19.89 (range: 14.84-20.99) mm. According to the patients’ distinct clinical characteristics, 14, 26, 22, and 30 eyes underwent Procedures Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. The median follow-up duration was 13 (range: 12-36)mo. At the final follow-up visit, all patients achieved a sustained intraocular pressure (IOP) below 21 mm Hg without the administration of anti-glaucoma medications. Postoperative complications included malignant glaucoma (MG, 9 eyes), uveal effusion (UE, 5 eyes), suprachoroidal hemorrhage (1 eye), fibrin membrane formation (4 eyes), uveitis (1 eye), macular edema (1 eye), and impaired corrected distance visual acuity (CDVA, 6 eyes). Univariate analysis revealed that younger age was associated with a higher risk of MG (OR: 1.06, P=0.04), UE (OR: 1.07, P=0.046), and impaired CDVA (OR: 1.11, P=0.02).

The modular surgical approach yields favorable and consistent clinical prognoses, while reducing the incidence of complications, in the challenging clinical scenario of ACG secondary to nanophthalmos.