The Clinical Study On The Treatment Of Acute Attack Angle-closure Glaucoma By Lensectomy

Object Study the efficacy of phacoemulsification extraction of lens and intraocular lens (IOL) implantation in therapy of acute angle-closure glaucoma. Methods Retrospective study on 13 cases (13eyes) of acute angle-closure glaucoma diagnosed in Sir Run Run Shaw hospital between Jan.2000 to Dem.2009. Medicines have been used to control intraocular pressure farthest before surgery in all trials. After the use of medicines, all trials have been divided into two groups, one has normal intraocular pressure and the other has higher intraocular pressure. The two groups have received phacoemulsification extraction of lens and intraocular lens (IOL) implantation. The intraocular pressure will be examined in the first day after operation, which will be detected until normal. The corrected visual acuity, intraocular pressure, anterior chamber angle (4 quadrants), images of UBM (ultrasonic biographic microscope) will be examined during the follow-up, which will be compared with those pre-operation. The follow-up raged from 3～41 months. Results There are 13 patients (13 eyes) elected for the inspection, composed of 3males (23%) and 10 females (77%), aging from 51 to 76(average 73), and the follow-up raged from 3 to 41 months (median 9.5). All 13 patients have even operations, and there are no serious complications in and after operation. The intraocular pressure after operation was significantly decreased to (14.80±2.53)mmHg.12 patients (92.3%) achieve the normal intraocular pressure without any medicine using after the surgery, the other 1 (7.7%)has higher intraocular pressure(35～45 mmHg) even 3 kinds of topical eyedrop medicines used. There was statistical difference between pre and post-operation (p＜0.001). The central anterior chamber depth after operation was significantly deepened to 3.53±0.30mm. There was statistical difference between pre and post-operation (p<0.001). The first group composed of 10 patients (76.9%) patients who has normal intraocular pressure on use of medicine pre-operation achieves normal intraocular pressure post-operation without any medicine, the other group composed of 3 patients (23.1%) who has higher intraocular pressure on use of medicine pre-operation has only 1 patient getting higher intraocular pressure even 3 medicines used post-operation. The result of gonioscopy pre-operation in 10 patients show us:there are 10 patients having osculant functional trabecula closure, composed of 7 patients (70%) whose osculant functional trabecula closure in 4 quadrants,1 patient (10%)in 2 quadrants and 2 patients(20%) in 1 quadrant, and the result turn to 3 patients (30%) having osculant functional trabecula closure only in 1 quadrants, the other 7 patients(70%) having any osculant functional trabecula closure left after the surgery; Among 3 patients(30%) with synechial functional trabecula closure pre-operation, the spectrum of synechial functional trabecula closure changed unconspicuously post-operation.1 patient (10%) has 4 quadrants synechial functional trabecula closure post-operation, who has 3 quadrants synechial functional trabecula closure pre-operation. getting higher intraocular pressure(35～45mmHg) even 3 kinds of medicines used post-operation. Compared with pre-operation (median 0.3), the BCVA (best corrected visual acuity) improved significantly post-operation (median 0.7). Conclusion The phacoemulsification extraction of lens and IOL implantation is efficacy and safe in the therapy of acute angle-closure glaucoma, achieving the goal of controlling of intraocular pressure and blocking the progress of glaucoma simultaneously. In the face of the most patients affected with acute angle-closure glaucoma, we should take trabeculectomy into consideration seriously.