Original Article Effect of adjunctive viscogonioplasty on drainage angle status in cataract surgery: a randomized clinical trial Yadollah Eslami MD, 1 Golshan Latifi MD, 1 Sasan Moghimi MD, 1 Reza Ghaffari MD, 1 Ghasem Fakhraie MD, 1 Reza Zarei MD, 1 Mahmood Jabbarvand MD, 1 Massood Mohammadi MD 1 and Shan Lin MD 2 1 Farabi Eye Research Center, Tehran University of Medical Science, Tehran, Iran; and 2 Department of Ophthalmology, San Francisco School of Medicine, University of California, San Francisco, California, USA ABSTRACT Background: To compare the anatomic effects of phacoemulsification (Phaco) versus combined phacoemulsification and viscogonioplasty (Phaco- VGP) on drainage angle status in primary angle- closure glaucoma (PACG) using anterior segment optical coherence tomography (AS-OCT). Design: Prospective, randomized clinical trial. Participants: Sixty-seven eyes of 57 patients with the diagnosis of PACG. Method: Patients were randomized to undergo Phaco alone (33 eyes) or Phaco-VGP (34 eyes). Patients were examined postoperatively on day 1, week 1 and week 6. Indentation gonioscopy and AS-OCT were performed preoperatively and at 6 weeks after surgery. Main Outcome Measures: Angle and anterior segment parameters by AS-OCT and amount of peripheral anterior synechiae (PAS) by gonioscopy. Results: Sixty-five eyes of 55 patients completed the trial. The mean extent of PAS was significantly reduced from 127.7 to 95.0 degrees (P < 0.001) by Phaco alone, and from 174.0 to 77.3 degrees (P < 0.001) by Phaco-VGP. Phaco-VGP resulted in significantly greater reduction in PAS extent (P = 0.002). Angle-opening distance and trabecular- iris space-area measured by AS-OCT increased significantly after Phaco alone and Phaco-VGP (P < 0.001 for both). Although the change was higher in the Phaco-VGP group, this did not reach statistical significance. Anterior chamber depth (ACD) increased, and lens vault (LV) decreased after both procedures. The amount of change in ACD and LV was not significant between the two groups. Conclusion: Both Phaco alone and Phaco-VGP resulted in widening of the drainage angle, deepen- ing of the anterior chamber and reduction of intraocular pressure (IOP) and PAS extent in PACG eyes. Phaco-VGP resulted in significantly more reduction of PAS. However, it seems that additional VGP has no significant effect on short-term IOP. Key words: anterior chamber depth, anterior segment optical coherence tomography, phacoemulsification, primary angle closure glaucoma, viscogonioplasty. INTRODUCTION Primary angle closure glaucoma (PACG) occurs when the anterior chamber drainage angle progres- sively narrows with a subsequent rise in intraocular pressure (IOP) leading to glaucomatous optic neu- ropathy. 1 The crystalline lens has a key role in con- figuring the anterior chamber (AC) and determining its biometric parameters. In angle-closure glaucoma,  Correspondence: Dr. Sasan Moghimi, Farabi Eye Research Center, Tehran University of Medical Science, Tehran, Iran. Email: sasanimii@yahoo.com Received 24 May 2012; accepted 12 August 2012. Competing/conflicts of interest: No stated conflict of interest. Funding sources: No stated funding sources. bs_bs_banner Clinical and Experimental Ophthalmology 2013; 41: 368–378 doi: 10.1111/j.1442-9071.2012.02871.x © 2012 The Authors Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists