Phacoemulsification For The Treatment Of Primary Angle Closure Glaucoma

Objective:To evaluate the efficacy of phacoemulsification combined with intraocular lens implantation in patients with primary angle-closure glaucoma and cataract.Methods:62 patients met the inclusion criteria in our hospital,including 62 eyes(26 PAC eyes and 36 PACG eyes).PACG patients were divided into early,middle and advanced stage based on the visual field staging system.The subjects were also grouped according to their PAS range.Patients were given topical medical treatment preoperatively and received phacoemulsification by a same surgeon.The visual acuity,intraocular pressure,anterior chamber depth,medication used,visual field and RNFL were observed before and after surgery for 6-24 months.Results:The mean age of the patients was 68±8.91 years,and the postoperative follow-up was 13.1±5.5 months.In all patients,postoperative visual acuity was improved(P<0.001),IOP decreased significantly(P<0.001),the number of medications was also significantly reduced(P<0.001),ACD was deeper than that before operation(P<0.001).There was no significant difference in visual field(P=0.973)and RNFL(P=0.268)after surgery.There seems no statistical difference between PAC and PACG in postoperative changes of various indexes.The decrease of IOP in early stage of PACG patients was significantly higher than that in the middle and advanced stages(F=3.519,P=0.041),and the number of medications used in early PACG patients was also significantly lower than that in the advanced patients(P=0.020).There exists no significant difference in postoperative visual acuity(X~2=0.139,P=0.987)and IOP decline(F=0.260,P=0.854)among patients with different preoperative ranges of PAS,and there was no statistical correlation between postoperative IOP control and preoperative PAS.No serious complications occurred in all the subjects.Conclusion:In PAC/PACG patients,phacoemulsification can control IOP,delay visual field defect and progressive loss of RNFL,which play a protective role in optic nerve.The efficacy of the early PACG patients was better than that of middle and advanced patients.PAC/PACG patients with different degrees of peripheral anterior synechiae can choose phacoemulsification,but close follow-up is necessary.