Study on Visual Quality After Cataract Surgery and Goniosynechialysis in Patients with Primary Angle-Closure Glaucoma and Cataracts

Abstract

Mingrui Chen,1,2 Jianhua Li,2,3 Qinyun Chen,2,3 Yuan Zhao2,3 1Department of Ophthalmology, People’s Hospital Affiliated to Chongqing Three Gorges Medical College, Chongqing, 404100, People’s Republic of China; 2Department of Ophthalmology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, 637000, People’s Republic of China; 3Medical School of Ophthalmology and Optometry, North Sichuan Medical College, Nanchong, Sichuan Province, 637000, People’s Republic of ChinaCorrespondence: Jianhua Li, Department of Ophthalmology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, 637000, People’s Republic of China, Email [email protected]: To assess the visual quality in patients with primary angle-closure glaucoma (PACG) complicated by cataracts after cataract phacoemulsification with intraocular lens (IOL) implantation and goniosynechialysis, and to explore the relationship between pupil size and visual quality.Methods: A retrospective, non-randomized study was conducted, including 65 PACG patients (75 eyes) who underwent cataract surgery with IOL implantation and goniosynechialysis from July 2021 to June 2023, as well as a control group of cataract-only patients. Visual quality was evaluated using objective and subjective methods at least 3 months postoperatively. PACG patients were divided into large-pupil (≥ 5 mm) and normal-pupil (< 5 mm) groups. Visual quality parameters were compared among groups, and correlations between pupil size and objective visual quality measures were analyzed.Results: Visual Parameters: The large-pupil PACG group showed significantly higher higher-order aberrations, including coma and spherical aberrations, compared to both the cataract and normal-pupil groups. Contrast sensitivity was also worse in the large-pupil group. Visual Quality Questionnaire: The large-pupil group reported higher scores for night glare and difficulty driving at night. Correlations: Pupil size was positively correlated with higher-order aberrations and negatively correlated with contrast sensitivity.Conclusion: Pupil dilation is a major factor affecting postoperative visual quality in PACG patients, even after surgery. Larger pupil size significantly increases higher-order aberrations and reduces contrast sensitivity. Techniques like pupil suturing may help improve visual quality in these patients.Keywords: primary angle closure glaucoma, visual quality, contrast sensitivity, higher-order aberrations

Keywords

• primary angle closure glaucoma；visual quality；contrast sensitivity；higher-order aberrations