Clinical Analysis Of 194 Cases Of Primary Angle Closure Glaucoma

Purpose: To assess the mechanism of primary angle closure glaucoma, and the therapeutic effect of glaucoma medications, laser treatment and glaucoma surgery.Method: Cross-sectional study of 194 patients, who were diagnosed to be primary angle closure glaucoma, treated in our hospital(China-Japan Union hospital) from 2005.1 to 2008.12. To be acute angle closure glaucoma or to be chronic angle closure glaucoma is dependent on the development of the intraocular pressure is suddenly or gradually. The acute angle closure glaucoma is divided into six phases on the basis of the different clinical: preclinical phase, premonition phase, acute phase, intermittent phase, chronic phase and absolute phase. Visual inspection, non-contact tonometer intraocular pressure measurement, slit-lamp examination to observe the size of the cornea, anterior chamber depth, gonioscopy and perimetry are routinely taken out. The application of the preoperative medication is based on the intraocular pressure and the degree of inflammation. In acute phase, trabeculectomy should be taked place after the intraocular pressure reduced to normal and the inflammatory reaction of anterior chamber controlled. If the intraocular pressure remains high for 72 hours, trabeculectormy should be taked place immediately. In other phases, the operation is taken place according to the angle-type: when the angle of anterior chamber is open or its adhesion range is less than 1/3 round, we choose iridectomy or laser iridectomy; when the angle of anterior chamber's adhesion range is extensive, we choose trabeculectomy. If patients accompanied with cataract, phacotrabeculectomy or phacotrabeculetomy should be chosen.Results: There was 194 patients in total who got primary angle closure glaucoma. Among those 194 patients, 132 were acute angle closure glaucoma, and 62 were chronic angle closure glaucoma. 3 patients were under 29 years, 5 were among 30 to 39 years, 13 were among 40 to 49 years, 64 were among 50 to 59 years, 57 were among 60 to 69 years, 44 were among 70 to 79 years and only 8 were above 80 years. 62 male and 132 female were primary angle closure glaucoma. 102 female and 30 male were acute angle closure glaucoma, and 30 female and 32 male were chronic angle closure glaucoma. 89 eyes were received glaucoma medicines, of which 75 were controlled; 69 eyes were received iridectomy, of which 68 were cured; 217 eyes were received trabeculectomy, of which 211 were cured; 10 eyes were received phacotrabecutomy, all of which were cured; 5 eyes were received laser iridectomy, all of which were cured. In preclinical phase and premonition phase, intraocular pressure of 2 eyes were out of control. These 2 eyes developed to the acute phase in 1 year after discharge, then re-admitted for trabeculectomy. 1 eye after iridectomy, the intraocular pressure was still mildly high. With given glaucoma medicine, that eye's intraocular pressure can be maintained in the normal range. In acute phase, intraocular pressure of one eye elevated in one month after trabeculectomy. That eye was taken place trabeculectomy again and was cured. In chronic phase, one eye's intraocular pressure was out of control after the trabeculectomy. The intraocular pressure of that eye was out of control again after re-trabeculectomy in 5 months. Then the eye was taked place phacoemulsification, and the intraocular pressure was controlled. In chronic angle closure glaucoma, intraocular pressure of four eyes was out of control, among the 4 eyes, two eyes was cured after re-trabeculectomy; one eye's intraocular pressure was still out of control after 2 times of trabeculectomy, then the eye was given glaucoma medicine to remain normal pressure; one eye's intraocular pressure can remain normal by given glaucoma medicine. In preclinical phase and premonition phase, 67 eyes were taken place iridectomy, only one of whose intraocular pressure was out of control. The rate of out-of-control was 1.49%. Trabeculectomy: in acute phase, 68 eyes were trabeculectomy. Among these, one eye was cured after re-trabeculectomy. The rate of out-of-control was 1.47%. In non-acute phase, 149 eyes were taken place trabeculectomy, of which 5 were out of control. 3 of the five eyes were given operation for 3 times. The rate of out-of-control was 3.36%. It can be seen that in chronic phase of acute angle-closure glaucoma and chronic angle-closure glaucoma, the rate of out-of-control of trabeculectomy is higher than that of acute phase of acute angle-closure glaucoma, and its postoperative intraocular pressure was more difficult to be control. The higher the preoperative intraocular pressure, the more severe inflammatory response after trabeculictomy. Compared with non-acute phase eyes, the acute phase eyes had more severe postoperative inflammatory response. Among 217 eyes be taken place trabeculectomy, 57 eyes occurred shallow anterior chamber: 37 eyes wereâ… degrees, 18 eyes wereâ…¡ degrees and 2 eyes wereâ…¢degrees. Among these, there were 2 eyes of ablatio chorioidea, 2 eyes of conjunctival leakage, 53 eyes of excessive filtration. 55 eyes were given conservative treatment; 1 eye was given scleral flap suture; 1 eye was given conjunctival flap repair. Conclusion: 1. The age of onset of primary angle-closure glaucoma focuses on between 50 to 79 years. 2. The number of acute angle-closure glaucoma is 2.13 times than chronic angle-closure glaucoma. In primary angle-closure glaucoma cases, the ratio of male to female was 1:2.13. In acute angle-closure glaucoma cases, the ratio of men to women is 1:3.4; and in chronic angle-closure glaucoma cases, the ratio of male to female is 1:1.3. Trabeculectomy is is the most effective method in the treatment of primary angle-closure glaucoma. 4. Iridectomy can prevent the acute angle-closure glaucoma from acute episode effectively. 5. Glaucoma medications could control intraocular pressure temporarily.