Phacoemulsification And Lens Implantation Combined With Goniosynechialysis For Primary Angle Closure Glaucoma

Purpose: To observe the clinical effects of phacoemulsification and lens implantation combined with goniosynechialysis(P/I+GSL)in the treatment of primary angle closure glaucoma(PACG).Methods and Materials: The prospective study successfully enrolled 39 PACG patients(43 eyes)that were about to undergo P/I+GSL surgery in Shenzhen eye hospital from November 2018 to August 2019.They were classified into APACG group and CPACG group and had completed 1 week,1 month,3 months and 6 months follow-up postoperatively.The best corrected visual acuity,intraocular pressure,anterior chamber depth,angle opening distance,trabecular iris space area,schlemm’s canal perimeter and schlemm’s canal area were compared and analyzed.Result: 1.Medications postoperatively: There was no reoperation during follow-up.The number of non-medication patient was 28 with 32 eyes(74.4%)while there were 3 with 3 eyes(11.5%)that were using one or two anti-glaucoma medications.The drug usage rate in APACG group was lower than in CPACG group.2.Best corrected visual acuity: There was a significant difference in BCVA between the two groups preoperatively.The BCVA in APACG group was worse than in CPACG group.The BCVA in both groups improved postoperatively and remained stable 3 months after operation.3.Intraocular pressure: The preoperative IOP in APACG group was higher than in CPACG group(p<0.05).The postoperative IOP after 6 months in APACG group was(15.17±2.99)mm Hg and(15.34±2.78)mm Hg in CPACG group.The IOP in both groups were significantly lower than those before operation.4.Central anterior chamber depth: The preoperative ACD was (1.69±0.27)mm in APACG group and(1.88±0.24)mm in CPACG group.There was significant difference between the two groups.The postoperative ACD after 6 months in APACG group was(3.24±0.25)mm and(3.14±0.27)mm in CPACG group.The ACD in both groups were significantly deeper than those before operation.5.Anterior chamber angle parameters: There was significant difference in ACA parameters between both groups and the ACA was significantly widen and deepen postoperatively.But the ACA after 6 months showed no difference.6.The detection rate of schelmm’s canal: The detection rate of schlemm’s canal in CPACG group preoperatively was lower than in APACG group and the control group.7.The morphological parameter of schlemm’s canal: There was no significant difference between APACG group and the control group preoperatively while the detection rate in CPACG group was significantly different from APACG group and the control group.Conclusion: Treating PACG with P/I+GSL can effectively deepen central anterior chamber depth and reopen closed-angle with fewer complications and prevent anterior chamber angle from closing again early in the postoperative period.Schlemm’s canal in CPACG patients can shrink and collapse preoperatively so that the efficacy in APACG is better than CPACG.However,schlemm’s canal can reopen after P/I+GSL.