Objective: 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.

Methods: 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.