The aim of this study is to observe the therapeutic effects of goniosynechialysis under gonioscope and phacoemulsification cataract extraction combined with posterior chamber intraocular lens implantation on acute angle-closure glaucoma (AACG) complicated with cataract, and analyze the influencing factors of postoperative refractive errors.

The clinical data of 148 patients (148 eyes) with AACG complicated with cataract treated in Handan Eye Hospital from April 2020 to June 2022 were selected. Among them, there were 40 males (40 eyes) and 108 females (108 eyes) ranged from 45 to 76 years with an average age of (58.8±9.9) years. All patients underwent phacoemulsification cataract extraction combined with posterior chamber intraocular lens implantation and goniosynechialysis under gonioscope. The best corrected visual acuity (BCVA), intraocular pressure, types of intraocular pressure-lowering drugs, angle opening distance (AOD)500, corneal curvature, axial length, central anterior chamber depth (ACD) and complications were recorded before and after surgery for 3 months. The BCVA, intraocular pressure, AOD500, corneal curvature, axial length and ACD followed a normal distribution and were expressed as ±s. Paired sample t test was used to compare the preoperative and postoperative data. The types of intraocular pressure-lowering drugs and complications did not meet the normal distribution and were expressed as median and interquartile range, compared by the Wilcoxon signed rank test before and after surgery. Pearson correlation analysis was used to analyze the correlation between postoperative refractive error and changes in BCVA, intraocular pressure, AOD500, shortening of axial length, and deepening of ACD.

The preoperative logarithm of the mean minimum resolution angle (logMAR) BCVA, intraocular pressure, types of intraocular pressure-lowering drugs, AOD500, corneal curvature, axial length, and ACD of all patients were (0.32±0.07), (25.17±4.08) mmHg (1 mmHg=0.133 kPa), and 3 (3, 4)types, (0.15±0.03) mm, (44.72±0.83) mm, (21.69±0.55) mm and (1.91±0.43) mm. After operation for 3 months, they were (0.06±0.02), (16.34±3.19) mmHg, 0 (0, 0)type, (0.57±0.12) mm, (44.69±0.85) D, (21.57±0.59) mm and (3.65±0.40) mm, respectively. There were significant differences in BCVA, intraocular pressure, AOD500, axial length and ACD before and after surgery (t=70.290, 29.552, -68.127, 2.561, -51.007; P<0.05); the types of intraocular pressure-lowering drugs (Z=-15.777, P<0.05). There were 9 cases (9 eyes) of primary anterior chamber hemorrhage, 6 cases (6 eyes) of anterior chamber exudation, 9 cases (9 eyes) of high intraocular pressure, which were controlled by drug. The postoperative refractive error was positively correlated with the shortening of axial length and the deepening of ACD (r=0.392, 0.423; P<0.05).

Goniosynechialysis under the gonioscope and phacoemulsification cataract extraction combined with posterior chamber intraocular lens implantation can effectively open the chamber angle, deepen the anterior chamber, reduce the intraocular pressure level, improve BCVA, and the milder postoperative complications. The shortening of axial length and the deepening of ACD are the influencing factors of postoperative refractive error.