{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:54:28Z","timestamp":1791222868155,"version":"4.1.0"},"reference-count":36,"publisher":"BMJ","funder":[{"name":"Guangzhou Regional Clinical High-Tech Project","award":["2026P-GX005"],"award-info":[{"award-number":["2026P-GX005"]}]},{"name":"Guangdong Basic Research Center of Excellence for Major Blinding Eye Diseases Prevention and Treatment","award":["2024-PIZC-016"],"award-info":[{"award-number":["2024-PIZC-016"]}]},{"name":"Science and Technology Program of Guangzhou, China","award":["2024A03J0250"],"award-info":[{"award-number":["2024A03J0250"]}]},{"DOI":"10.13039\/501100002858","name":"China Postdoctoral Science Foundation","doi-asserted-by":"publisher","award":["2023M744052"],"award-info":[{"award-number":["2023M744052"]}],"id":[{"id":"10.13039\/501100002858","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82401251"],"award-info":[{"award-number":["82401251"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82571203"],"award-info":[{"award-number":["82571203"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Science and Technology Program of Sichuan Province","award":["2020YJ0289"],"award-info":[{"award-number":["2020YJ0289"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2026,9,22]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To assess the 3-year efficacy and safety of combined surgical peripheral iridectomy (SPI), goniosynechialysis (GSL) and goniotomy (GT) for advanced primary angle-closure glaucoma (PACG) without cataract.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a multicentre prospective observational study with extended follow-up. We enrolled advanced PACG without cataract patients who underwent combined SPI+GSL+\u2009GT and completed 36-month follow-up. Key outcomes included changes in intraocular pressure (IOP), best-corrected visual acuity (BCVA), usage of anti-glaucoma medications, surgical success rates, progression of peripheral anterior synechiae (PAS), endothelial cell density, visual field (VF) mean deviation (MD) and long-term postoperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 70 eyes from 58 patients were included in the final analysis. Baseline mean IOP (29.4\u00b18.1\u2009mm Hg) decreased to 16.4\u00b14.01\u2009mm Hg at 36 months (40.7\u00b118.8%\u2009reduction, p&lt;0.001), with anti-glaucoma medications declining from 2.0\u00b11.4\u2009to 0.7\u00b10.9 (p&lt;0.001), representing a 65.7% reduction in required medications postoperatively. At the 3-year follow-up, the cumulative complete and qualified success rates were 54.3% and 84.3%, respectively. Median BCVA worsened slightly (0.00 vs 0.10 logarithm of the minimum angle of resolution, p&lt;0.001); 21.4% of eyes had significant vision loss (\u22652 Snellen lines), attributable to cataract progression. MD of VF remained stable (p=0.217). Main late complications were cataract requiring surgery (n=10) and persistent PAS (n=11), with no vision-threatening events. Older age correlated with higher 3-year surgical success (p&lt;0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Combined SPI+GSL+GT provides sustained IOP reduction, stable visual function, and a favourable safety profile over 3 years, supporting its role as a reliable long-term treatment for advanced PACG without cataract.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2026-329527","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:20:24Z","timestamp":1791220824000},"page":"bjo-2026-329527","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Three-year outcomes of combined surgical peripheral iridectomy, goniosynechialysis and goniotomy for advanced primary angle-closure glaucoma: a multicentre study"],"prefix":"10.1136","clinical-trial-number":[{"clinical-trial-number":"nct05163951","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1760-237X","authenticated-orcid":false,"given":"Fengbin","family":"Lin","sequence":"first","affiliation":[{"name":"State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaomin","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, 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