{"doi":"10.1016/j.ajoc.2020.100808","title":"Juvenile angle closure management: The role of lens extraction and goniosynechialysis","abstract":"PURPOSE: Angle closure (AC) is a rare condition in young people. In adults with AC, lens extraction and goniosynechialysis (LE-GSL) are effective in restoring angle anatomy and function. However, the efficacy of LE-GSL is poorly understood in the juvenile population. In this study, we report the efficacy and safety of LE-GSL in a series of young patients with AC. METHODS: We reviewed the medical records of consecutive patients with AC. Eyes were included if aged <40 years at the time of diagnosis, had angle closure, at least one month of postoperative follow-up, and had undergone LE-GSL between January 1, 2015 and June 30, 2019. Eyes were excluded if they had undergone prior incisional glaucoma surgery. AC was defined as elevated untreated intraocular pressure (IOP) > 24 mmHg and (1) less than 180° of visible trabecular meshwork, or (2) any peripheral anterior synechiae noted on gonioscopy, or (3) iridocorneal apposition prior to dilation > 180° identified on anterior segment imaging. RESULTS: A total of 11 eyes (7 patients) were included. The mean ages of diagnosis and LE-GSL were 19.0 and 21.2 years, respectively. Of the 11 eyes, 8 had a history of laser retinal ablation for the treatment of retinopathy of prematurity (ROP, 72.7%). Intraoperatively, 7 eyes received intraocular lens (63.3%), 6 had concurrent vitrectomy (54.5%), and 4 had concurrent endocyclophotocoagulation (36.4%). Following LE-GSL, visual acuity (VA) improved from a mean preoperative LogMAR of 0.88 (20/150 Snellen equivalence) to a mean LogMAR of 0.68 (20/100 Snellen equivalence, P = 0.029). IOP significantly decreased from 18.2 mmHg (Tmax 38.4±12.2 mmHg) preoperatively to a mean of 11.3 mmHg postoperatively (P = 0.009). The number of glaucoma medications was significantly reduced from a mean of 2.4 preoperatively to no medications at final follow-up (mean duration of 13.7 months, P < 0.001). There were no significant intra- or postoperative complications in any eyes. CONCLUSIONS AND IMPORTANCE: In our cohort, LE-GSL significantly lowered IOP, improved visual outcomes, and decreased medication burden in young patients with AC, many of which had infantile retinal ablation for ROP. LE-GSL may be considered an effective intervention in young patients with AC.","journal":"American Journal of Ophthalmology Case Reports","year":2020,"id":85547,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":5,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9611,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":309188,"name":"Audina M. Berrocal","orcid":"0000-0002-2446-2184","position":1,"is_corresponding":false},{"id":323000,"name":"Alana L. Grajewski","orcid":"0000-0002-7438-4196","position":2,"is_corresponding":false},{"id":308563,"name":"Ta Chen Chang","orcid":"0000-0003-4827-5014","position":3,"is_corresponding":false},{"id":424101,"name":"John Y. Lee","orcid":"0000-0001-7328-1972","position":0,"is_corresponding":true}],"reference_count":5,"raw_metadata":null,"created_at":"2026-07-18T21:58:16.217017Z","pmid":"32642598","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}