Vision-related quality of life after phacoemulsification combined with goniosynechialysis and goniotomy in patients with primary angle-closure glaucoma and cataract

To assess vision-related quality of life by using patient-reported outcomes (PROs) measures after phacoemulsification with intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) and goniotomy (GT) in patients with primary angle-closure glaucoma (PACG) and cataract, and explore its association with IOP, BCVA, and medication burden. This retrospective study enrolled 31 eyes from 31 PACG patients who received PEI + GSL+GT from January 1, 2024 to February 1, 2025. Intraocular pressure (IOP), logMAR best corrected visual acuity (BCVA), number of topical intraocular pressure-lowering medications, and complications were detected at baseline and at postoperative 1-day, 1-week, 1-month, 3-month, 6-month and 12-month. The total score of Glaucoma Quality of Life 15 (GQL-15) and Glaucoma Symptom Scale (GSS) from baseline to 12 months was collected. Surgical success was estimated using Kaplan–Meier methods. IOP decreased from 27.2 ± 7.8 to 16.0 ± 3.2 mmHg at 12 months (95% CI, 8.4–13.9; P < 0.0001). The number of topical IOP-lowering drugs decreased from 2.55 ± 0.81 to 0.06 ± 0.25 (95% CI, 2.17–2.80; P < 0.0001). GQL-15 total score decreased from 36.3 ± 11.5 to 29.1 ± 10.0 (95% CI, 5.05–9.27; P < 0.0001). GSS total score increased from 71.2 ± 13.9 to 77.6 ± 12.8 (95% CI, 3.56–9.10; P < 0.0001). LogMAR BCVA improved from 1.14 ± 0.74 at baseline to 0.65 ± 0.74 at 12-month (95% CI, 0.28–0.71; P < 0.001). Twelve-month Kaplan-Meier success was 0.742 (95% CI, 0.550–0.862). Major complications were microhyphema (4/31, 12.9%), transient corneal edema (1/31, 3.2%), and suspected steroid-related postoperative IOP elevation (3/31, 9.7%). Microhyphema and corneal edema resolved within 1 week, and suspected steroid-related postoperative IOP elevation resolved after discontinuation of topical corticosteroids. No malignant glaucoma, persistent hypotony, or reoperation occurred. PRO changes showed no stable correlations with changes in IOP, BCVA, or medication burden. PEI + GSL+GT was associated with improved vision-related quality of life and lower IOP, reduced medication burden, and improved BCVA over 12 months. PROs provided complementary information that extends beyond the scope of conventional clinical metrics.