The Changes Of Postoperative Retinal Nerve Fiber Layer,blood Flow And Visual Field After Acute Angle-closure Attack In Patients With Primary Angle-closure Glaucoma(PACG)Following Retinal Hemorrhage

Objective:The patients with PACG have different prognosis after surgery.Sometimes we can observe that the patients with PACG who evidenced optic disc swelling and hemorrhages in different layers of retinal immediately following trabeculectomy.Retinal hemorrhages have important value in the occurrence and development of a ocular disease.Based on comparing the changes of optical coherence tomography angiography(OCTA),visual field and color fundus photography at different time after the surgery of patients with primary angle-closure glaucoma(PACG)following retinal hemorrhage,the aim of this essay is to analyze the associations among vessel density,and structural,functional measures.Methods:Perspective study of patients who were diagnosed of PACG in the acute attack stage for the first time and undertaken trabeculectomy performed from October 2017 to January 2019.All patients included the preoperative intraocular pressure greater than 50 mmHg and postoperative intraocular pressure lower than 21 mmHg.The group of fundus hemorrhage included 15 cases(15 eyes)with retinal hemorrhages and optic disc swelling,fellow preclinical eyes were analyzed for comparison.The normal group included 15 fellow preclinical eyes in patients apart from retinal hemorrhages.In the group of fundus hemorrhage patients underwent the best corrected visual acuity(BCVA),intraocular pressure,color fundus photography,OCTA and visual field after 1 day of surgery and recorded the results of those examinations after 2 weeks and 3 months of surgery.Besides that,the normal group took OCTA examination after 3 months of surgery..Recorded and compared the parameters of whole image vessel density(WVD),optic nerve head vessel density(OVD),average peripapillary vessel density(PVD),and inferonasal,nasal,superonasal,superotempora l,temporal,inferotemporal peripapillary vessel density,average macular superficial vessel density(MVD),average RNFL thickness and inferonasal,nasal,superonasal,superotemporal,temporal,inferotemporal RNFL thickness,average ganglion cell complex(GCC)thickness,mean deviation(MD),pattern standard deviation(PSD);and made statistical analysis.Results:1.In the group of retinal hemorrhage eyes,the best corrected visual acuity(P<0.001)and the mean deviation(P<0.001)had been improved with time(1day,2weeks,3months)after surgery and there were statistically significant difference while the PSD showed no significant difference(P=0.417).Compared with the control eyes,the BCVA in the retinal hemorrhage eyes had been decreased significantly 1day,2weeks after surgery.2.The whole image vessel density(WVD)had been decreased with time(1day,2weeks,3months)after surgery(P<0.001),while the macular superficial vessel density(MVD)showed no significant difference(P=0.054).Compared with the control eyes,the WVD and MVD in the retinal hemorrhage eyes had been decreased significantly(P<0.001).3.As the time(1day,2weeks,3months)after surgery went by,the ganglion cell complex(GCC)(P<0.001),average and all quadrants RNFL thickness(P<0.05)gradually become thinner.There was a statistically significant difference for retinal nerve fiber layer(RNFL)thickness between 1day,3months and control eyes.(P<0.001).Compared with the control eyes,the GCC in the retinal hemorrhage eyes had been decreased significantly 2weeks,3months after surgery(P<0.001).4.Compared with the control eyes,the RNFL thickness and PVD in the quadrants of IN,SN,ST,IT of retinal hemorrhage eyes decreased more significantly than the other quadrants 3months after surgery.5.Control eyes showed a significant difference for WVD compared to normal eyes(P<0.05)and were positively correlated with WVD of retinal hemorrhage eyes 3 months after surgery.(r=0.790,P<0.001).6.In the group of retinal hemorrhage eyes,the associations among PVD and MD,RNFL thickness is positive 1day(r=0.469,r=0.449),2weeks(r=0.616,r=0.745),3months(r=0.800,r=0.923)after surgery.Conclusion1.The BCVA and visual field of primary angle-closure glaucoma(PACG)following retinal hemorrhage eyes partially recover when retinal hemorrhages and optic disc swelling vanish.2.In patients with PACG following retinal hemorrhage,WVD,PVD,MVD,RNFL thickness and GCC thickness decrease and can’t recover during the observation.3.In the quadrants of IN,SN,ST,IT of primary angle-closure glaucoma(PACG)following retinal hemorrhage eyes have poorer blood supply and more severe damage of retinal nerve fiber.4.The patients with dysfunction of retinal vessels tend to suffer retinal hemorrhage after acute angle-closure attack in patients with PACG.5.The vessel density have correlation with the damage of structure and function.