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

Objective: 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