The Clinical Effect Of Phacoemulsification Combined With Trabeculectomy And Phacoemulsification Combined With Goniosynechialysis For Acute Primary Angle Closure Glaucoma With Cataract

Objective: To evaluate and compare the clinical effect and safety of phacoemulsification combined with trabeculectomy and phacoemulsification combined with goniosynechialysis for acute primary angle-closure glaucoma with cataract.Objects and methods: Retrospective analysis research 67 patients (70 eyes) ,from August 2006 to August 2009 in chongqing ninth people's hospital of the ophthalmic hospital patients with acute primary angle-closure glaucoma with cataract were involved;including 25 males (26 eye, one of them was both eyes), 42 women (44 eye, two of them were both eyes). 33 eyes were done phacoemulsification implanted artificial crystal combined with trabeculectomy (hereinafter referred to as the trabecular group), 37 eyes were done phacoemulsification implanted artificial crystal combined with goniosynechialysis (hereinafter referred to as the goniosynechialysis group); through the observation of two different operative ways groups of patients with Intraocular pressure(IOP), visual acuity, central anterior chamber depth(CAC), peripheral anterior chamber depth(PAC), anterior chamber angie, thickness of lens(TL),axial length of ocular(AL),TL/AL ratio),, postoperative medication and complications with 3-12 months,analyzes surgery to treat the way of the clinical curative effect for acute primary angle-closure glaucoma with cataract.Results:1 Intraocular pressure(IOP): Preoperative IOP was 45.83±15.97mmHg, postoperative IOP was 15.18±5.62 mmHg in trabecular group (P < 0.01);preoperative IOP was 41.36±13.06 mmHg ,postoperative IOP was 17.09±7.66mmHg in goniosynechialysis group (P < 0.01). The reduction of IOP was 30.66±14.15 mmHg in trabecular group , the reduction of IOP was 22.35±8.72mmHg in goniosynechialysis group , which showed statistically significant (P < 0.05).2 Visual acuity: 27 eyes (81.8%) visual acuity postoperative were improved more than 1 line at the end of time ,4 eyes (12.1%) had no change in visual basic, 1 eye(3.1%) visual acuity droped more than 1 line in trabecular group; the trabecular group of preoperative and postoperative visual acuity was statistically significant in the constituent ratios (χ2 = 31.061, P < 0.01).34 eyes (91.9%) visual acuity postoperative were improved more than 1 line,2 eyes (5.4%) had no change , 1 eye (2.7%)visual acuity droped more than 1 line in goniosynechialysis group; the goniosynechialysis group of preoperative and postoperative visual acuity was statistically significant in the constituent ratios (χ2= 32.996, P < 0.01).The trabecular group and the goniosynechialysis group of visual acuity compared was not statistically significant (χ2 = 4.863, P = 0.677).3 Central anterior chamber depth(CAC): Preoperative CAC was 1.4706±0.2034 mm, postoperative 3.2794±0.3772 mm in trabecular group (P < 0.01) ; preoperative CAC was 1.5168±0.1879 mm, postoperative 3.5832±0.3186 mm in goniosynechialysis group (P < 0.01)。The trabecular group and the goniosynechialysis group of postoperative CAC was deepened 1.8088±0.3879mm and 2.0665±0.2784 mm respectively,which showed statistically significant (P < 0.01).4 Peripheral anterior chamber depth(PAC) and anterior chamber angle:4.1 PAC: The trabecular group of preoperative and postoperative PAC were 1.1515±0.3641 and 2.9091±0.2919 respectively (P < 0.01); the goniosynechialysis group of preoperative and postoperative PAC were 1.1081±0.3148 and 3.9730±0.1644 respectively (P < 0.01). 4.2 Anterior chamber angle: Adopt spaeth,(a classification of anterior chamber angle);A,B,C,D respectively as 1,2,3,4 for statistical analysis, the trabecular group of preoperative and postoperative anterior chamber angle were 1.0606±0.2423 and 3.6061±0.4962 respectively (P < 0.01);the goniosynechialysis group of preoperative and postoperative anterior chamber angle were 1.1078±0.3145 and 3.9149±0.2767 respectively(P < 0.01);postoperative the trabecular group and the goniosynechialysis group anterior chamber angle were 3.6061±0.4962 and 3.9189±0.2767 respectively, which showed statistically significant (P = 0.002).5 Thickness of lens(TL),axial length of ocular(AL),TL/AL ratio:5.1 TL:Preoperative the trabecular group and the goniosynechialysis group TL were 5.0482±0.2311 mm and 5.0584±0.2274 mm respectively, with no statistically significant difference (P = 0.853); postoperative trabecular group and goniosynechialysis group artificial crystal thickness are less than 1mm, the change of TL was statistically significant between two groups。5.2 AL: Preoperative and postoperative AL of the trabecular group were 21.7858±0.5374mm and 21.8176±0.5209mm respectively, with no statistically significant difference (P = 0.102); preoperative and postoperative AL of the goniosynechialysis group were 21.8138±0.5526mm and 21.8543±0.4808mm respectively, with no statistically significant difference (P = 0.086).5.3 TL/AL ratio: The preoperative TL/AL ratio of trabecular group and goniosynechialysis group were 0.2319±0.0121 and 0.2321±0.0125 respectively, with no statistically significant difference( P = 0.944); the postoperative TL/AL ratio of two groups were 0.0446±0.0113 and 0.0447±0.0115 respectively,with no statistically significant differenc (P = 0.967).6 The postoperative complications: postoperative corneal edema had 5 eyes (15.2%) in trabecular group , 5 eyes (13.5%) in goniosynechialysis group;Iris cellulose sample oozy and anterior chamber inflammation had 5 eyes (15.2%) in trabecular group , 2 eyes (5.4%) in goniosynechialysis group ;maligmant glaucoma had 2 eyes (6.1%) in trabecular group , 1 eye (2.7%) in goniosynechialysis group ;postoperative shallow anterior chamber had 6 eyes (18.2%) in trabecular group , 1 eye (2.7%) in goniosynechialysis group;Conjunctival follicular leakage had 2 eyes (6.1%) in trabecular group ;choroidal detachment had 3 eyes (9.1%) in trabecular group , 0 eye (0%) in goniosynechialysis group;the pupil artificial crystal adhesion had 3 eyes (9.1%) in trabecular group , 2 eye (5.4%) in goniosynechialysis group; late-development sex cataract had 2 eyes (6.1%) in trabecular group , 1 eye (2.7%) in goniosynechialysis group。7 The success rate: The all 67 patient(s70 eyes)had 60 eyes (85.71%) with completely successful , 7 eyes (10.00%) condition success , 3 eyes (4.29%) failure ;among them the trabecular group (total 33 eyes) had 30 eyes (90.91%) with completely successful , 2 eyes (6.06%)conditions success ,1 eyes (3.03%) failure ; the goniosynechialysis group (37 eyes) had 30 eyes (81.08%) with completely successful , 5 eyes(13.51%) conditions success,2 eyes (5.41%) failure .Conclusion: phacoemulsification combined with trabeculectomy and phacoemulsification combined with goniosynechialysis to treatment acute primary angle-closure glaucoma with cataract are all safe and effective methods。For the clinical curative effect in IOP the trabecular group was better than the goniosynechialysis group. For the deepening of amplitude in CAC and the change amplitude of shape of anterior chamber angle the goniosynechialysis group was better than the trabecular group。The trabecular group had more postoperative complications compared the goniosynechialysis group.