PURPOSE:To assess real-world canaloplasty outcomes in glaucoma management using standardized data from an international registry. DESIGN:The iTrack Global Data Registry (iTGDR) is an ongoing prospective real-world multicenter observational study on ab-interno canaloplasty with the iTrack or iTrack Advance (Nova Eye Medical), with or without concomitant cataract surgery. PARTICIPANTS:Patients diagnosed with ocular hypertension or glaucoma (excluding angle-closure glaucoma). METHODS:Analysis included eyes with a minimum 12 months follow-up from the iTGDR. Both standalone canaloplasty and canaloplasty combined with cataract surgery were included. Intraocular pressure (IOP) and glaucoma medications were assessed at baseline and postoperative follow-ups. Surgical success was defined according to the 2024 American Academy of Ophthalmology (AAO) criteria. MAIN OUTCOME MEASURE:IOP, number of glaucoma medications, and success rate at last follow-up (LFU). RESULTS:Two hundred and fifty-four patients (344 eyes) were followed over a mean of 20.5 ± 7.9 months (LFU). Following combined canaloplasty and phacoemulsification (n = 313 eyes), mean IOP and medication usage reduced from 17.2 ± 5.3 mm Hg and 2.1 ± 1.1 preoperatively to 14.1 ± 3.9 mm Hg and 1.3 ± 1.4 at LFU (P < .001); 61.9% of all combined eyes achieved success (increasing to 83% in eyes with baseline IOP > 18 mm Hg), while 43% of eyes became medication-free (vs 7% preoperatively). Standalone canaloplasty (n = 24 eyes) reduced IOP and medication usage from 20.2 ± 7.1 mm Hg and 2.3 ± 0.9 to 15.3 ± 6.3 mm Hg and 1.5 ± 1.6 (P < .01); 35% of eyes achieved success, and 46% of eyes became medication-free (vs none preoperatively). IOP and medication reductions were significant across glaucoma subtypes (primary and secondary open-angle glaucoma, ocular hypertension) and severities (P < .01 for all). The rate of additional glaucoma procedures was 4.9%, including laser procedures; no canaloplasty-related sight-threatening complications were reported. A loss of ≥2 lines of corrected distance visual acuity occurred in 7.3% of eyes, most commonly in association with pre-existing advanced disease or unrelated ocular comorbidities. CONCLUSION:In real-world clinical practice, iTrack canaloplasty significantly reduced IOP and medication burden with a favorable safety profile when performed alone or with phacoemulsification and in diverse glaucoma populations.

BACKGROUND/AIMS:Minimally invasive glaucoma surgery (MIGS) procedures are commonly combined with phacoemulsification to provide additional intraocular pressure (IOP) and/or topical medication reduction in patients with mild-to-moderate glaucoma. This study compared the 1-year efficacy and safety of excimer laser trabeculostomy (ELIOS) versus trabecular micro-bypass stenting (iStent inject and iStent inject W), both performed in combination with cataract surgery. METHODS:This multicentre retrospective cohort study included patients undergoing combined phacoemulsification with either ELIOS (Phaco-ELIOS) or iStent implantation (Phaco-iStent) at three European centres between 2020 and 2025. The primary endpoint was IOP at 12 months postoperatively. Secondary endpoints included longitudinal IOP and medication use, surgical success, adverse events and the need for secondary glaucoma surgery. Longitudinal outcomes were analysed using multiple imputation. RESULTS:A total of 343 eyes were included (164 Phaco-ELIOS and 179 Phaco-iStent), with 1-year follow-up available in 70%. Mean IOP decreased by 21.6% for Phaco-ELIOS and 20.7% for Phaco-iStent and remained stable through 12 months (p=0.74). Both procedures were associated with a similar reduction in postoperative topical glaucoma medications (0.56 vs 0.41; p=0.2). With Phaco-ELIOS, a higher proportion of eyes achieved medication reduction (46.4% vs 31.3%; p=0.02). Rates of adverse events and secondary glaucoma surgery were low and comparable in both groups. CONCLUSION:Phaco-ELIOS and Phaco-iStent provided comparable 1-year IOP reduction and overall safety. Phaco-ELIOS showed a greater number of patients with topical medication reduction, supporting its role as an effective combined MIGS option in patients undergoing cataract surgery.

The current concept is that the eye is an immune privileged site endowed with innate immune regulatory networks to maintain organ function. We now have evidence that resident T cells occupy intraocular tissues. In immune-mediated inflammatory diseases, such as psoriasis and rheumatoid arthritis, tissue resident T cells trigger disease flares in the skin and joints. This suggests resident T cells in the uvea may have similar functions in non-infectious immune-mediated uveitis, a collective term for autoinflammatory and autoimmune diseases of the uveal tract causing intraocular inflammation. Here, we demonstrate by spectral cytometry and immunofluorescence imaging that non-inflamed uveal tissue contains multiple T cell subtypes including CD8+ CD103+ tissue resident memory T (TRM) cells. Using single cell RNA & T cell receptor (TCR) sequencing to profile aqueous humour cells from donors with acute, active uveitis, we identify clonally expanded T cells which are enriched for TRM-associated genes. We further show that in donors with active uveitis, CD8+ CD103+ T cells persist within tissue in the uveal tract. Using bulk RNA sequencing and weighted gene co-expression network analysis (WGCNA) we show that quiescent iris tissue from donors with a history of uveitis are enriched for genes associated with T cell activation and antigen presentation. Finally, we demonstrate that TRM cells persist in the anterior uvea in mice following resolution of experimental autoimmune uveoretinitis (EAU). Our results show that the human eye contains T cells both in health and during active inflammation. Our findings challenge the dogma that the eye is devoid of lymphocytes and supports the concept of resident T cell involvement in the pathogenesis of non-infectious immune-mediated uveitis and as promising targets for therapy.

PURPOSE:To evaluate the 3-year efficacy and safety of phacogoniotomy versus phacotrabeculectomy for advanced primary angle-closure glaucoma (PACG) with cataract. DESIGN:Multicenter, randomized controlled, open-label, non-inferiority trial. METHODS:Patients were randomized 1:1 to undergo either phacogoniotomy (65 eyes) or phacotrabeculectomy (59 eyes). Three years retention was 92.3% (60/65) and 83.1% (49/59) for each group, respectively. Primary outcome was 3-year intraocular pressure (IOP) reduction (noninferiority margin: 4 mmHg). Secondary outcomes included surgical success, complications, hypotensive medications used; additional outcomes were changes in visual acuity (BCVA), visual field (VF), and corneal endothelial cell density (ECD). RESULTS:At 3 years, phacogoniotomy reduced mean IOP from 40.2 (10.3) to 14.1 (2.4) mmHg (-26.1 [10.4] mmHg reduction); phacotrabeculectomy, from 39.7 (9.3) to 14.4 (2.5) mmHg (-25.3 [9.2] mmHg reduction). Adjusted between-group difference in IOP change was -0.37 mmHg (95% CI, -1.32-0.58 mmHg; P = 0.44), meeting noninferiority. Complete (78.3% vs 89.8%; P = 0.13) and qualified (90.0% vs 91.8%; P > 0.999) success rates were comparable. Hypotensive medications declined in both groups (phacogoniotomy: 2.1 [1.2] to 0.2 [0.6]; phacotrabeculectomy: 2.1 [1.3] to 0.0 [0.2]; P = 0.06 for 3-year difference). BCVA improvements (0.1 vs 0.0 logMAR; P = 0.49), VF stability (MD difference:1.42 dB, P = 0.26; PSD difference: 0.22 dB, P = 0.75), and ECD loss (difference: 2%; P = 0.53) were similar. No new complications occurred in extended follow-up. CONCLUSIONS:At 3 years, phacogoniotomy remained non-inferior to phacotrabeculectomy in IOP reduction for advanced PACG with cataract.

PURPOSE:To compare canaloplasty and trabecular micro-bypass surgery outcomes in primary open-angle glaucoma (POAG). METHODS:Ambispective study using data from the International Glaucoma Surgery Registry (IGSR) to evaluate mild-to-moderate POAG patients who underwent iTrack ab-interno canaloplasty (Nova Eye Medical, USA) (prospective cohort) or iStent trabecular micro-bypass implantation (Glaukos, USA) (retrospective cohort), with or without concomitant phacoemulsification, and ≥12 months of follow-up. Primary outcomes were intraocular pressure (IOP), medication usage, and surgical success as defined by the American Academy of Ophthalmology (2024). RESULTS:The study included 339 eyes (iStent: n = 115; iTrack: n = 224) of which ≥94% underwent concomitant phacoemulsification (iStent: n = 109, iTrack: n = 210). There were nonsignificant differences in baseline IOP (p = 0.417) and medications (p = 0.741) between groups. At last follow-up, mean IOP (mmHg) and medication usage decreased from 17.3 ± 4.2 and 2.0 ± 1.1 at baseline to 14.2 ± 3.5 and 1.3 ± 1.1 in the iStent group (p < 0.001; mean follow-up: 27.2 ± 14.5 months), and from 16.9 ± 5.0 and 2.0 ± 1.1 at baseline to 14.3 ± 3.4 and 1.1 ± 1.3 in the iTrack group (p < 0.001; mean follow-up: 20.3 ± 7.7 months). Both groups showed no significant differences in reduction of IOP (p = 0.422) and medications (p = 0.211). More eyes were medication-free in the iTrack group (42% vs 29%; p = 0.029). Success was achieved in 61% of eyes in both groups (p = 1.000). Postoperatively, both groups demonstrated infrequent and self-limited complications, no sight-threatening events, and low reoperation rates. CONCLUSION:In POAG, iTrack canaloplasty and iStent implantation showed no statistically significant differences in effectiveness outcomes. Both procedures had favourable safety profiles with limited additional glaucoma surgeries. More canaloplasty eyes were medication-free compared to stent eyes.

PURPOSE:Uveitic glaucoma (UG) is a complex disease with nearly three times higher risk for severe visual loss than uveitis without glaucoma. Monitoring and management vary among ophthalmologists, making it difficult to identify optimal follow-up and treatment approaches. The Uveitic Glaucoma Interest Group (UGIG) proposes guidelines to reduce variation in practice through best practice management guidelines for uveitis-related ocular hypertension (UOHT) and UG. METHODS:A group of ophthalmologists with expertise in uveitis and glaucoma conducted an extensive literature review of UOHT and UG. Following review and discussion generated recommendations to standardize best management practices. RESULTS:The recommendations cover: 1) glaucoma-related testing and timing, 2) intraocular pressure (IOP) monitoring and goals, 3) follow-up after starting corticosteroids (CS) or IOP-lowering agents, 4) timing of referral to a glaucoma specialist, 5) management considerations and guidelines. CONCLUSIONS:Uveitic eyes have a heightened risk of developing ocular hypertension (OHT) and glaucoma. IOP is often very high and highly variable, associated with rapid progression rates from OHT to glaucoma, and with more rapid visual field loss. Glaucoma can also develop at lower IOP as compared to non-uveitic patients. The UGIG proposes recommendations to standardize the care of UG patients, facilitating more effective management and optimizing visual outcomes. A consensus is presented regarding IOP management based on a more stringent IOP threshold of 16 mmHg. When possible, a close collaboration between a glaucoma specialist and the uveitis expert is preferred. Appropriate referral to glaucoma specialist should be made early, ideally at the time IOP-lowering therapy is initiated.

Importance:The safety and effectiveness of combining surgical peripheral iridectomy (SPI) with goniosynechialysis (GSL) and goniotomy (GT) vs trabeculectomy for intraocular pressure (IOP) reduction remains unknown. Objective:To investigate the safety and effectiveness at 1 year of SPI + GSL + GT vs trabeculectomy in advanced primary angle-closure glaucoma (PACG) without cataract. Design, Setting, and Participants:This noninferiority randomized clinical trial was conducted at 8 tertiary eye centers in China. A total of 88 Chinese patients (88 eyes) with advanced PACG without cataract were enrolled from January 2022 to July 2023. Data were analyzed from August 2024 to September 2024. Mean (SD) patient age was 60.3 (7.3) years, and 52 patients (59.1%) were female. Forty-three patients were randomized to SPI + GSL + GT and 45 were randomized to trabeculectomy; 86 patients (97.7%) completed the 12-month follow-up. Interventions:Participants were randomized 1:1 to receive SPI + GSL + GT or trabeculectomy. Main Outcomes and Measures:The primary outcome was IOP at 12 months (noninferior margin: 4 mm Hg). Secondary outcomes included surgical success (IOP: 5-18 mm Hg, ≥20% reduction from baseline, with or without antiglaucoma medications); postoperative complications and interventions, including bleb massage, suture lysis, or releasable sutures; and number of antiglaucomatous medications prescribed. Results:At 12 months, the SPI + GSL + GT group had a mean (SD) IOP of 15.6 (4.0) mm Hg vs 14.9 (4.2) mm Hg in the trabeculectomy group (difference, 0.5 mm Hg; 95% CI, -1.2 to 2.2; P = .55), which was within the 4-mm Hg noninferiority margin. Qualified success rates were 38 of 43 participants (88.4%) for SPI + GSL + GT and 42 of 45 participants (93.3%) for trabeculectomy (difference, -5.0%; 95% CI, -19.6% to 8.5%; P = .48). However, complete success rates were lower in the SPI + GSL + GT group (26 participants [60.5%]) vs the trabeculectomy group (37 participants [82.2%]; difference, -21.8%; 95% CI, -40.2% to -2.4%; P = .03). Postoperative complications were present for 8 participants (18.6%) in the SPI + GSL + GT group vs 9 participants (20.0%) in the trabeculectomy group (difference, -1.4%; 95% CI, -17.9% to 15.1%; P = .71). Postoperative interventions were lower in the SPI + GSL + GT group (3 participants [7.0%] vs 25 participants [55.6%]; difference, 48.6%; 95% CI, 32.2%-65.0%; P < .001). Median (IQR) numbers of medications used decreased from 2 (0-3) to 0 (0-1) in the SPI + GSL + GT group and from 2 (2-3) to 0 (0-0) in the trabeculectomy group (difference, -0.81; 95% CI, -1.36 to -0.26; P = .004). Conclusions and Relevance:In this randomized clinical trial among patients with advanced PACG without cataract, SPI + GSL + GT demonstrated noninferiority (4-mm Hg margin) to trabeculectomy for IOP at 12 months, with fewer interventions (including bleb massage, suture lysis, or releasable sutures) but no difference in postoperative medication use. This suggests SPI + GSL + GT as a potential alternative to trabeculectomy for similar cases, pending validation in larger sample sizes with smaller noninferiority margins. Trial Registration:ClinicalTrials.gov Identifier: NCT05163951.

Importance:Intraocular pressure (IOP) reduction with phacogoniotomy (phacoemulsification plus goniosynechialysis plus goniotomy) was not less than that of phacotrabeculectomy for advanced primary angle-closure glaucoma (PACG) with cataract at 1-year follow-up, but longer-term outcomes are needed. Objective:To investigate if phacogoniotomy is noninferior to phacotrabeculectomy for advanced PACG with cataract at 2 years. Design, Setting, and Participants:This multicenter, noninferiority, randomized clinical trial took place in 7 ophthalmology centers in China. The trial started May 31, 2021, and 2-year follow-up ended May 31, 2024. Included in this analysis were patients with advanced PACG and cataract. Study data were analyzed from September 2024 to January 2025. Interventions:Random assignment (1:1) to phacogoniotomy or phacotrabeculectomy. Main Outcomes and Measures:The primary outcome measure was reduction in IOP from baseline to the 2-year visit with a noninferiority margin of 4 mm Hg. Results:A total of 124 participants (124 eyes) were randomized (mean [SD] age, 66.4 [8.6] years; 67 female [54.0%]), 65 (52.4%) to the phacogoniotomy group and 59 (47.6%) to the phacotrabeculectomy group. A total of 59 patients (90.7%) in the phacogoniotomy group and 52 patients (88.1%) in the phacotrabeculectomy group completed 2-year visits. All participants were Chinese. Mean (SD) IOP reduction was -25.6 (10.2) mm Hg and -24.7 (9.4) mm Hg in the phacogoniotomy and phacotrabeculectomy groups, respectively, and the upper boundary of the CI for difference in change between groups was lower than the 4-mm Hg noninferiority margin (mean difference, -0.5 mm Hg; 97.5% CI, -1.7 mm Hg to 0.8 mm Hg; P = .42). The mean difference for complete success for phacogoniotomy vs phacotrabeculectomy was -6.7% (95% CI, -21.4% to 8.8%; P = .47) and for qualified success was 1.4% (95% CI, -11.0% to 14.3%, P = .30). Median (IQR) number of antiglaucomatous medication was 0 (0) vs 0 (0; Hodges-Lehmann estimate of location shift, 0; 95% CI, 0; P =.12) with phacogoniotomy vs phacotrabeculectomy, respectively (mean difference, 0.13; 95% CI, -0.36 to 0.63; P = .60). Conclusions and Relevance:Mean IOP reduction with phacogoniotomy was noninferior to phacotrabeculectomy for advanced PACG and cataract at 2-year follow-up with no differences detected in complete or qualified success or mean number of antiglaucomatous medications. These findings support phacogoniotomy as an alternative to phacotrabeculectomy for patients with advanced PACG and cataract. Trial registration:ClinicalTrials.gov Identifier: NCT04878458.

Importance:Primary selective laser trabeculoplasty (SLT) is a safe primary treatment for open-angle glaucoma (OAG) and ocular hypertension (OHT). However, there is limited evidence on its use as a secondary treatment, ie, after prior use of ocular hypotensive eye drops. Objective:To evaluate outcomes following SLT after using hypotensive eye drops for at least 3 years. Design, Setting, and Participants:This is a post hoc exploratory analysis of data from a multicenter randomized clinical trial conducted within the UK National Health Service. Participants were patients with OAG or OHT who participated in the LiGHT trial. Data were analyzed from February 2021 to December 2024. Intervention:Participants were initially randomized to either primary SLT or primary hypotensive eye drops and remained on the allocated treatment pathway for 3 years. Participants using eye drops were then allowed to have secondary SLT as a treatment switch (to reduce their medication load) or as a treatment escalation (if more intense treatment was needed). Participants were treated and monitored according to a predefined protocol. Main Outcomes and Measures:The outcomes of interest were rates of incisional glaucoma surgery, medication use, and intraocular pressure. Results:In total, 633 participants entered the extension of the LiGHT trial, and 524 participants (82.8%) completed the extension (72 months). Of 320 participants receiving primary hypotensive eye drops, 112 (35.0%) received SLT: 70 participants switched to SLT, 29 participants had SLT as a treatment escalation, and 13 participants had SLT as a treatment escalation in 1 eye and as a treatment switch in the other eye. Switching to SLT was associated with a reduction in the number of medications (mean [SD], 1.38 [0.62] to 0.59 [0.92] active ingredients; mean difference, 0.79 [95% CI 0.66 to 0.93] active ingredients; P < .001). At 72 months, 69 eyes that switched to SLT (60.5%) needed no medical or surgical treatment, and 62 eyes receiving 1 drug before switching (83.8%) needed no medical treatment. Escalating to SLT was associated with a mean intraocular pressure reduction of 4.6 mm Hg (21.8%), and 30 eyes (62.5%) reached target intraocular pressure at 72 months without the need for surgery; 9 eyes (18.7%) needed a trabeculectomy. Conclusions and Relevance:This secondary analysis of a randomized clinical trial found that secondary SLT was associated with a reduction in the medication load for stable, medically treated eyes. For medically uncontrolled eyes, there is evidence that SLT could provide additional intraocular pressure control, but the need for trabeculectomy was not eliminated. Trial Registration:isrctn.org Identifier: ISRCTN32038223.

Purpose: To evaluate the safety and efficacy outcomes of aqueous shunt implant with/without intraoperative mitomycin-C (MMC) in glaucoma secondary to congenital Aniridia and risk factors associated with its success. Design: Retrospective study Subjects: Patients with congenital Aniridia who underwent aqueous shunt implantation with/without intraoperative MMC for glaucoma at Moorfields Eye Hospital London between 2012 and 2021 with at least 3 years follow-up. Methods: The primary outcome was success at 3 years defined by intraocular pressure (IOP) reduction ≥ 20 % from baseline and final IOP between 6 and 21 mmHg with/without (overall) or without (complete) medications, without further glaucoma surgery or loss of light perception. Results: Altogether 28 eyes of 23 patients were included, with a mean age of 33.1 (SD 18.3) years. The baseline IOP, medications and visual acuity were 23.4 (SD 8.3), 3.0 (SD 0.9) and 1.6 (SD 0.7) logMAR respectively. Intraoperative MMC was used in 15 (53.6 %) cases. At 3 years the proportion of complete and overall success was 44.0 % and 92.0 % respectively, with a significant reduction in IOP (-11.0, CI -14.0 to -8.0, p < 0.001) and medication use (-1.7, CI -2.3 to -1.2, p < 0.001), and no significant change in VA. There was no significant association between baseline IOP, number of medications and VA, lens status, MMC use, removal of stent suture and surgical success. Conclusions: Aqueous shunt implant is effective at reducing IOP and medication use at 3 years in glaucoma secondary to congenital Aniridia, with no significant change in visual acuity observed post-operatively.

To report the 2-year effective and safety profile of integrated phacoemulsification with intraocular lens implantation (PEI), goniosynechialysis (GSL) and 120° goniotomy (GT) in advanced primary angle-closure glaucoma (PACG) and cataracts. Multicentre prospective study. 201 eyes of 196 patients who received combined PEI+GSL+ GT were assessed at baseline and re-evaluated at days 1, 7, and at 1, 3, 6, 12 and 24 months postsurgery. The intraocular pressure (IOP), the number of topical hypotensive medications, surgical complications and achievements of surgery success were also evaluated. All participants were followed up for a 2-year period. The average IOP declined from 33.0±10.7 mm Hg to 13.6±2.9 mm Hg, and the number of topical hypotensive medication decreased from an average of 2.4 types to 0.4 at month 24. For the safety profile, the major complications were hyphema (n=14, 7.0%), IOP spike (n=9, 4.9%) and transit corneal oedema (n=23, 11.4%). The complete success was achieved in 72.6% of the eyes (146 out of 201), and the qualified success rate was 91.5% (184 out of 201). Only one eye required tube shunt surgery while no one developed severe vision-threatening complications. The best-corrected visual acuity increased from 0.80±1.08 to 0.54±0.78 LogMAR. PEI+GSL+GT is shown to be effective and safe in treating advanced PACG with cataract over a 2-year follow-up period. The combined surgery may be considered as an alternative for patients with advanced PACG.

BACKGROUND/AIMS:To investigate the efficacy and safety of intraluminal ripcord suture removal (ROS) from the Paul glaucoma implant (PGI). METHODS:A retrospective cohort study involving all PGI ripcord removal cases at a single centre between 1 January 2018 and 1 November 2023. The primary outcome was defined as a ≥20% reduction in intraocular pressure (IOP), or a decrease in IOP-lowering medications, at 3 months post-ROS. RESULTS:145 eyes of 131 patients were included. The mean interval between PGI implantation and ROS was 181.9±131.4 days. 70.3% of eyes met the primary endpoint of success, with second tubes and infero-nasal tube placement significantly associated with reduced success (p<0.05). Compared with the pre-ROS mean IOP (19.5±6.7 mm Hg), the post-ROS IOPs at 1 week, 1 and 3 months were significantly reduced to 12.7±7.4 mm Hg, 15.3±6.1 mm Hg and 13.7±5.3 mm Hg, respectively (p<0.0001). Similarly, the number of IOP-lowering medications was significantly reduced to 0.44±0.97, 0.75±1.18 and 1.12±1.30, respectively (p<0.005). Post-ROS complications included clinically significant hypotony (n=10, 6.9%), of which 6 eyes (4.1%) required surgical ripcord re-insertion, tube shunt occlusion (n=2, 1.4%) and post-ROS uveitis (n=1, 0.69%). We found no predictive factors for post-ROS hypotony, including the time of ROS since PGI surgery. CONCLUSIONS:ROS from PGI resulted in at least 20% IOP or medication reduction in over 70% of eyes. Second and inferonasal tubes had reduced success. Clinical hypotony is the most common complication, without association with the time of stent removal since PGI implantation.

PURPOSE:To evaluate the two-year outcomes of combined surgical peripheral iridectomy (SPI), goniosynechialysis (GSL), and goniotomy (GT) for advanced primary angle-closure glaucoma (PACG) without cataract. DESIGN:Multicenter prospective study. METHODS:The study included patients who received a combined SPI + GSL + GT for advanced PACG without cataract, all completed a 24-month follow-up. Outcome measures included changes in intraocular pressure (IOP), best-corrected visual acuity (BCVA), use of anti-glaucoma medications, surgical success, and postoperative complications over the 24-month period. RESULTS:A total of 63 eyes from 51 patients with advanced PACG were included in the study. Among these, 37 eyes (58.7 %) achieved complete success, and 55 eyes (87.3 %) achieved qualified success. The mean IOPs at baseline and after 24 months were 28.8 ± 7.51 mm Hg and 15.8 ± 4.40 mm Hg, respectively (P < 0.001). The average number of anti-glaucoma medications decreased from 1.9 ± 1.4-0.8 ± 1.2 over the 24-month period (P < 0.001). The overall BCVA was stable during the follow-up period (P = 0.225). The primary complications observed included IOP spike (n = 9), hyphema (n = 7), and shallow anterior chamber (n = 3), all of which occurred within the first month postoperatively. Regression analysis showed that older age was positively associated with both complete success [odds ratio (OR) = 1.05; P = 0.030] and qualified success (OR = 1.08; P = 0.024). CONCLUSIONS:SPI + GSL + GT demonstrated safety and effectiveness in treating advanced PACG without cataract over the 24-month study period. This combined surgical approach should be considered a viable alternative to trabeculectomy for these patients.