The synergy of phacoemulsification and bio-grafts: a new era in acute glaucoma management

Abstract

Introduction. Acute angle-closure glaucoma (AACG) presents as an ophthalmic emergency characterized by abrupt, severe increasesin intraocular pressure (IOP), leading to irreversible apoptosis of retinal ganglion cells. Contemporary approaches increasingly support definitive lens extraction as an adjunct to conventional pressure-lowering therapies. In addition, the incorporation of biological tissue modulation strategies is being explored to optimize ocular hemodynamics and promote neural survival, preventing the risk of surgical failure caused by fibrosis. Methods and materials. This study analyzed literature on MIGS and biological grafting from articles (2016-2026) using PubMed. Search optimization utilized MeSH terms (“Phacoemulsification”, ”Amniotic membrane”) and keywords. The review incorporated national protocols and international data on amniotic membrane and MSC derivatives. Results. Early phacoemulsification resolves pupillary blockage, maintaining a mean post-operative IOP of 14.2 mmHg. Utilizing an amniotic membrane (AMT) as a “bio-shield” correlates with a 23% success rate increase (p< 0.01) by modulating wound healing and preventing subconjunctival fibrosis. In Republic of Moldova this synergy reduced post –operative inflammation by 40%. Research on MSC-derived exosomes shows a 26% improvement in ganglion cell density, suggesting a potential for functional neuroregeneration. Conclusions. The evolution of acute glaucoma management is marked by a transition from mechanical pressure control to biological reconstruction. The synergy between phacoemulsification and bio-grafts provides an objective framework for both pressure control and structural neuroprotection. This evidence-based approach confirms the viability of advanced regenerative protocols as a sustainable evolution in acute glaucoma management.