| Objective: To compare efficacy of coaxial microincisions(1.8 mm,2.2 mm)and small incisions(3.0mm)on phacoemulsification combined with trabeculectomy for primary angle-closure glaucoma(PACG)with cataract.Methods: Ninety-six patients(96 eyes)with PACG and cataract were recruited and randomly divided into three groups between January 2015 and June 2017.3.0 mm-incision group,2.2 mm-incision group,and 1.8 mm-incision group comprised 30,34 and 32 eyes respectively.All cases were treated with clear corneal incision phacoemulsification combined with trabeculectomy.Data including best corrected visual acuity(BCVA),corneal astigmatism,corneal endothelial cell counts(CECC),intraocular pressure(IOP),and complications were collected before the operation,and at postoperative 1d,1mo and 3mo.Results: All the patients were successfully treated with surgery.The BCVA of 2.2 mm-incision group and 1.8 mm-incision group were significantly improved as compared to 3.0 mm-incision group at postoperative 1d,1mo and 3mo(all P <0.05).The corneal astigmatism of 3.0 mm-incision group was statistically higher than that of 2.2 mm-incision group(P =0.026);corneal astigmatism of 2.2mm-incision group was statistically higher than that of 1.8 mm-incision group at postoperative 1d(P=0.006).The corneal astigmatism of 3.0 mm-incision group at postoperative 3mo was significantly higher than that before operation(P =0.003).At postoperative 1mo and 3mo,corneal astigmatism of2.2 mm-incision group and 1.8 mm-incision group were significantly lower than that of 3.0mm-incision group(all P <0.05).The CECC in 2.2 mm-incision group was significantly higher than that of 3.0 mm-incision group(P =0.020),and CECC in 1.8 mm-incision group was significantly higher than that of 2.2 mm-incision group(P =0.034)at postoperative 1d.At postoperative 1mo and3 mo,CECC of 2.2 mm-incision group and 1.8 mm-incision group were significantly higher than that of 3.0 mm-incision group(all P <0.05).In each group,postoperative mean IOP at each time interval was significantly lower than preoperative IOP(all P <0.05).At all time points before and after operation,there was no significant difference between the three groups in IOP(P >0.05).Conclusion: Coaxial microincision phacoemulsification combined with trabeculectomy for PACG with cataract has better curative efficacy in reducing postoperative corneal astigmatism and corneal endothelial cell injury than traditional small incision combined surgery,and the 1.8 mm microincision has better curative efficacy than 2.2 mm microincision in the early postoperative period.Objective: To study the effect of 1.8 mm coaxial phacoemulsification combined with trabeculectomy on ocular surface.Methods: Forty patients(45 eyes)with primary angle-closure glaucoma with cataract were randomly divided into observation group and control group.In the observation group,1.8 mm incision phacoemulsification combined with trabeculectomy was performed in 24 eyes and 3.0 mm incision phacoemulsification combined with trabeculectomy was performed in 21 eyes in the control group.ocular surface disease index score(OSDI),non-invasive first tear rupture time(Nif BUT),non-invasive average tear rupture time(Nia BUT),tear meniscus height(TMH),corneal fluorescein staining scores(CFS)were measured at preoperative,postoperative 1w,postoperative 1mo and postoperative 3mo respectively.Results: 1.OSDI: At 1w after operation,the OSDI of the two groups increased,and the control group increased more severely than the observation group with statistical difference(P <0.05).At 1mo and3 mo after operation,the OSDI of the two groups decreased gradually,and the two groups did not return to the preoperative level.At 1mo after operation,the control group was still significantly higher than the observation group.2.Nif BUT,Nia BUT: The Nif BUT and Nia BUT of the two groups decreased significantly at 1w after operation,and the Nif BUT,Nia BUT of the control group was significantly lower than that of the observation group Nia BUT.After 1mo,3mo,the Nif BUT,Nia BUT of the two groups gradually recovered,still did not return to the preoperative level.After1 mo,the Nif BUT,Nia BUT of the control group was still significantly lower than that of the observation group(P <0.05).3.TMH: TMH decreased in both groups at 1 w after operation,which was statistically significant(P <0.05),and TMH decreased more significantly in the control group than in the observation group(P <0.05).The TMH of the two groups gradually recovered at 1mo and3 mo after operation.4.CFS: At 1 w after operation,the CFS of both groups increased,compared with the observation group,the control group increased more significantly,the difference was statistically significant(P <0.05).After 1mo,3mo,the CFS of the two groups decreased gradually,and the two groups did not return to the preoperative level,the difference was statistically significant(P <0.05).The CFS in the control group was still significantly higher than that in the observation group at 1mo after operation(P <0.05).Conclusion: phacoemulsification combined with trabeculectomy can affect the stability of tear film,and the effect of coaxial phacoemulsification combined with trabeculectomy with 1.8 mm microincision on the ocular surface is smaller than that of 3.0 mm incision.Objective: To investigate the effect of microincision lens removal on lacrimal membrane and IL-6,TNF-α of ocular surface in rabbit eye model.Methods: Thirty-one New Zealand rabbits(31 eyes)were randomly divided into microincision group(10 eyes),conventional incision group(9 eyes)and normal control group(12 eyes).The normal control group was not treated.A model was made both In the microincision group and the conventional incision group.The microincision group underwent 2.2 mm incision lens removal,and the conventional incision group underwent 3.2 mm incision lens removal.BUT was examined in both the microincision group and the conventional incision group at preoperative and postoperative1 w,postoperative 2w.Detection of TNF-α,IL-6 in tears by ELISA were also done at the above time points.Three groups of rabbits were executed at 2w after operation,and the expression of corneal TNF-α,IL-6 was detected by Western Blot method.Results: The BUT of the microincision group and the conventional incision group were significantly decreased at 1w after operation,and the decrease of the conventional incision group was more obvious(P <0.05).The BUT of the two groups recovered at 2w after operation and did not return to the preoperative level.The BUT of the microincision group were still long and the difference was statistically significant(P <0.05).The TNF-α and IL-6 in tear of two groups were significantly increased in the postoperative 1w,2w.However,there was no significant difference between the two groups(P >0.05).After 2w,the expression of TNF-α and IL-6 in corneal tissue of conventional incision group and microincision group were both significantly higher than that of normal control group(P <0.05),and there was no significant difference between the two operation groups(P >0.05).Conclusion: the stability of lacrimal membrane was less damaged by microincision than by conventional incision,and the ocular surface inflammatory response caused by both was comparable. |
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