Clinical Discussion Of The Relationship Of Postoperative Shallow Anterior Chamber Of Angle-Closure Glaucomatous Trabeculectomy With Preoperative Cyclodialysis And That With Intraocular Pressure

Shallow of anterior chamber is the commonest early postoperative complication of filtering operation of glaucoma. The common reasons for ocular hypotensive shallow anterior chamber consist of excessive filtration, conjunctival leakage and ciliochoroidal detachment. Because of the crypticity of ciliary body position, the diagnosis of cyclodialysis was always the difficult point for ophthalmologic examination. The examination of ciliary body became possible because of the invention of ultrasound biomicroscopy (UBM). There are many researches about postoperative cyclodialysis of glaucomatous filtering operation, but there are not so many reports about preoperative cyclodialysis of primary glaucoma. Using UBM we found preoperative cyclodialysis of some patients in 251 cases that were diagnosed as primary glaucoma. Their IOP and parameters of ocular anterior segment were recorded and statistical treated to summarize and analyze the relationship between postoperative shallow anterior chamber of angle-closure glaucomatous trabeculectomy and preoperative cyclodialysis/intraocular pressure.Objective: To explore the relationship between postoperative shallow anterior chamber of angle-closure glaucomatous trabeculectomy and preoperative cyclodialysis/intraocular pressureMethods: The clinical data of 251 cases diagnosed as primary glaucoma between June 2006 and March 2007 were analyzed. Sixteen angle-closure glaucomatous eyes (16 cases) were found cyclodialysis by UBM. Using tonometer and UBM to observe and measure the IOP, ocular anterior segment image and parameters of 9 in 16 eyes with cyclodialysis(Group A) and 25 angle-closure glaucoma eyes(21 cases) without cyclodialysis (Group B) which were all treated with trabeculectomy(excluding excessive filtration and conjunctival leakage). Summarize and analyze the relationship between postoperative shallow anterior chamber (PSAC) of angle-closure glaucomatous trabeculectomy and preoperative cyclodialysis/intraocular pressure.Results:1. The incidence of preoperative cyclodialysis in primary glaucoma was 6.37%. This kind of patients was all diagnosed as angle-closure glaucoma, and the incidence in angle-closure glaucomawas 7.84%. Among them, 7 cases were in acute episode phase of acute angle-closure glaucoma, 4 cases were in chronic phase of acute angle-closure glaucoma and 5 cases were chronic angle-closure glaucoma. There was no statistical significant difference of gender and age between Group A and B.2. The admission state of Group A was as following. Visual perception: PM/10cm~0.8. IOP: 16~65mmHg, average (38.67±6.08) mmHg. Aqueous Tyndall phenomenon: 2 cases were Grade 0, 5 cases were (+), 2 cases were (++) and no case was (+++) or (++++). Gonioscopy findings: Angle-closure of no case was less than 180°, 7 cases were more than 180°but less than 360°and 2 cases were 360°.3. IOP comparison of Group A and B: Group A: the average preoperative IOP (IOPpre) was (38.67±6.08) mmHg; the average postoperative IOP for the first day(IOPpost) was (15.00±1.30) mmHg, the average IOP descending amplitude(IOPpre-IOPpost) was (23.56±5.80)mmHg. Group B: the average IOPpre was (38.40±16.08) mmHg; the average IOPpost was (13.84±1.34) mmHg, the average IOPpre-IOPpost was (25.12±3.15) mmHg. There was no statistical significant difference of IOPpre, IOPpost and IOPpre-IOPpost.4. UBM consequence comparison of Group A and B: the common appearance was corneal edema, shallow anterior chamber, spot echo of unequal amount and medium intensity in anterior chamber, ectasia iridis and narrow even close angle of anterior chamber. Compare with the UBM image of Group B, there could be one or two characteristics in Group A as follow. There was an anechoic area or low echo area between sclera and ciliary body (supraciliary cavity); the orbiculus ciliaris could be separated between layers. The detachment of ciliary body was annular in 5 cases and quadrantal in 4 cases. Group A: the average corneal thickness(CT) was (0.6775±0.0172)mm; the average anterior chamber depth(ACD) was (1.6944±0.085)mm; the average number of quadrant whose iris-lens angle was zero (Countθ1=0) was (2.9±0.6); the average trabecula-iris angle (θ2) was (12.62±1.08)°; the average trabecular-ciliary process distance(TCPD) was (0.4709±.0323)mm; the height of cyclodialysis was 0.0259~0.3451mm, average (0.1706±0.0782)mm. Group B: the average CT was (0.6385±0.0149)mm; the average ACD was (1.7320±0.0715)mm; the average Countθ1=0 was (3.0±0.2); the averageθ2 was (13.50±0.60)°; the average TCPD was (0.4530±0.0085)mm. There was no statisticalsignificant difference of CT, ACD, Countθ1=0°,θ2 and TCPD between Group A and B.5. State of PSAC in Group A and B: 2 cases(2 eyes) had PSAC in Group A(22.22%); 8 eyes (7 cases) had PSAC in Group B(32.00%). There was no statistical significant difference of these two incidence rates.6. Relationship between PSAC and IOP: In all there were 10 eyes(9 cases) had PSAC in both groups(29.41%). Group PSAC: the average IOPpre was (49.90±4.70) mmHg; the average IOPpost was (9.75±0.98) mmHg, the average IOPpre-IOPpost was (38.30±4.33)mmHg. Group non-PSAC: the average IOPpre was (33.71±3.02) mmHg; the average IOPpost was (15.76±1.74) mmHg, the average IOPpre-IOPpost was (19.04±2.72)mmHg. There was statistical significant difference of IOPpre, IOPpost and IOPpre-IOPpost between PSAC and non-PSAC eyes.7. Relationship between PSAC and UBM parameters: Group PSAC: the average CT was (0.6544±0.0246)mm; the average ACD was (1.7579±0.1110)mm; the average Countθ1=0 was (3.0±0.3); the averageθ2 was (14.53±0.44)°; the average TCPD was (0.4649±0.0233)mm. Group non-PSAC: the average CT was (0.6779±0.0462)mm; theaverage ACD was (1.7070±0.0669)mm; the average Countθ1=0 was (3.0±0.2); the averageθ2 was (12.74±0.70)°; the average TCPD was (0.4548±0.0114)mm. There was statistical significant difference ofθ2 between PSAC and non-PSAC eyes(P<0.05) while there was not of other UBM parameters.Conclusion:1. Preoperative cyclodialysis all happened in angle-closure glaucoma patients, including acute episode and chronic phase of acute angle-closure glaucoma and chronic angle-closure glaucoma.2. UBM can be used to observe the morphous and measure the parameters of ocular anterior segment which provide important evidence for the diagnosis of primary glaucoma with cyclodialysis.3. Cyclodialysis of primary glaucoma can be annular or quadrantal.4. No dependability between pre-trabeculectomy cyclodialysis and postoperative shallow anterior chamber can be found.5. The higher of preoperative IOP, the larger of iris-lens angle and IOP descending amplitude, the lower of postoperative IOP for the first day, the bigger of the possibility of postoperative shallow anteriorchamber.