Investigation Of Effect Of Anti-glaucoma Surgeries On Ocular Surface For Patients Combined With Primary Glaucoma And Cataract Through Oculus Keratograph 5M

Part 1To evaluate the effect of three anti-glaucoma surgeries on patients of primary glaucoma combined with cataractObjective:to analyze the effect of three anti-glaucoma surgeries on patients of primary glaucoma combined with cataract.Methods:this is randomized,prospective control study.We collected 82 patients of primary glaucoma combined with cataract from September 2016 to March 2017 in our hospital.7 cases of primary open-angle glaucoma combined with cataract,31 cases of primary acute angle-closure glaucoma combined with cataract,44 cases of primary chronic angle-closure glaucoma combined with cataract.According to surgical options principle for primary glaucoma combined with cataract,25 cases of primary angle-closure glaucoma combined with cataract accepted phacoemulsification,posterior chamber intraocular lens implantation combined with goniosynechialysis(Phaco-IOL-GSL group);30 patients with primary glaucoma combined with cataract experienced phacoemulsification?posterior chamber intraocular lens implantation combined with trabeculectomy(phacotrabeculectomy group);A total of 27 patients with primary glaucoma combined with cataract underwent simple trabeculectomy(trabeculectomy group).The preoperative and postoperative vision acuity,intraocular pressure,anterior chamber depth and angle were observed respectively.Results:The visual acuity was significantly improved followed by Phaco-IOL-GSL group group,and the visual acuity of the trabecular group was not significantly improved.The intraocular pressure of the three groups was no significant difference before surgery,and was significantly statistical lower postoperatively than preoperatively(p<0.05).The intraocular pressure of Phaco-IOL-GSL group was significantly higher than that of the trabeculectomy group and the phacotrabeculectomy group at 3 days postoperatively.The intraocular pressure of the three groups reached normal level at 1 week postoperatively and was not significantly different between the three groups(p>0.05).Conclusion:phacoemulsification,posterior chamber intraocular lens implantation combined with goniosynechialysis is a safe and effective treatment for patients of primary closed-angle glaucoma combined with cataract.Part 2To investigate the effect of three anti-glaucoma surgeries on ocular surface of patients for primary glaucoma combined with cataract by using ocular Keratograph 5MObjective:To investigate the influence of different anti-glaucoma surgery on ocular surface for patients combined with primary glaucoma and cataract by using Keratograph 5MMethods:this is randomized,prospective control study.112 samples without dry eyes included 82 patients combined with primary glaucoma and cataract,30 cataract patients.82 primary glaucoma included 7 primary open-angle glaucoma,31 primary acute angle-closure glaucoma and 44 primary chronic angle-closure glaucoma were divided into three study groups as phacoemulsification,intraocular lens implantation combined with trabeculectomy(phacotrabeculectomy)group(N=3 0);and intraocular lens implantation combined with goniosynechialysis(Phaco-IOL-GSL)group(N=25);trabeculectomy group(N=27).Thirty cataract patients accepted phacoemulsification as control group.Ocular surface disease index score(OSDI),noninvasive keratograph first tear film break-up time(Nif:BUT),noninvasive keratograph average tear film break-up time(NiaBUT),tear meniscus height(TMH),corneal fluorescein staining score(CFS),conjunctival congestion score and meibomian gland function was assessed in the preoperative at 3 days,1 month,3 months postoperatively through Oculus Keratograph 5 M.Results:Patients underwent surgery and complete the final follow-up.There were no significantly statistical differences among ages,gender and intraocular pressure for three study groups,age was statistically significant different in the control group and experimental group,operation time had obvious statistical difference,preoperative ocular surface parameters were not significantly statistical different for four groups.The intraocular pressure effect of Phaco-IOL-GSL group was slightly worse than the phacotrabeculectomy group and the trabeculectomy group at 3 days postoperatively and there was no significant difference for the three study groups at 1 month and 3 months postoperatively.The Phaco-IOL-GSL group had better visual recovery than the other two study groups1.OSDI:the OSDI was increased at 3 days postoperatively for four groups,and the three study groups were more serious and statistical different.The OSDI gradually decreased at 1 month,3 months postoperatively,the Phaco-IOL-GSL group and the control group were recovered to the preoperative level without statistical difference at3 months postoperatively.The OSDI of phacotrabeculectomy group and trabeculectomy group did not return to preoperative level and there was statistical difference at 3 months postoperatively(P<0.001).2.NifBUT and NiaBUT:Each NifBUT and NiaBUT were dropped significantly for four groups,which were statistically different compared with preoperative(P<0.001),Phaco-IOL-GSL group and the control group didn't show significantly statistical difference(P>0.05)and was basically restored to preoperative level at 1 month postoperatively.NifBUT and NiaBUT did not recovery to preoperative level at 3 months postoperatively for phacotrabeculectomy group and trabeculectomy group.3.TMH:TMH was increased in each group at 3 days postoperatively.The phacotrabeculectomy group and the trabeculectomy group had statistically significant differences compared to the other two groups at 3 months postoperatively and there was no statistical difference between the Phaco-IOL-GSL group and the control group.4.Conjunctival congestion scores:At 3 days postoperatively,the conjunctival congestion was obvious and gradually improved over time.At 1 month postoperatively,conjunctival congestion was receded and there was no significant statistically difference compared with the preoperative for Phaco-IOL-GSL group and control group.Conjunctival congestion scores for phacotrabeculectomy group and trabeculectomy group were more serious,there were still significantly statistical differences compared with preoperative.5.CFS:The CFS of each group was increased and the phacotrabeculectomy group was more serious and statistically different than the other two groups at 3 days postoperatively(P<0.001).The CFS of the control group and Phaco-IOL-GSL group was restored to the preoperative level at 3 months postoperatively and there was no statistical difference.There was no statistically significant difference between phacotrabeculectomy group and trabeculectomy group at 3 months postoperatively6.Meibomian gland function evaluation:lid margin scores,meibum gland opening scores,meibum quality scores and meibomian gland loss scores.The lid margin scores were all increased,and there was significant statistical difference compared with baseline at 3 days postoperatively for the four groups.Meibum gland opening scores,meibum quality scores and meibomian gland loss scores were increased,but there was no statistical difference compared with baseline(P = 0.023),meibomian gland loss scores were increased significantly,and there was statistical difference for the phacotrabeculectomy group and the trabeculectomy group at 3 months postoperatively(P<0.05).7.Correlation between the OSDI and ocular surface parameters:OSDI was negatively correlated with NifBUT and NiaBUT(rs=-0.718,p<0.001;rs =-0.535,p=0.002),OSDI was positively correlated with CFS(rs=0.038,p<0.001)and no correlated with TMH(rs=-0.143?p=0.841)for phacotrabeculectomy at 3 months postoperatively.Conclusion:1.The tear film stability of four groups was decreased after surgery.The severity of the tear film stability was was in order of the phacotrabeculectomy group,the trabeculectomy group and Phaco-IOL-GSL group2.The tear film stability was restored to baseline for Phaco-IOL-GSL group and phacoemulsification group at 1 month postoperatively.Ocular surface parameters did not restore to preoperative levels and there were significantly statistical differences for the phacotrabeculectomy group and the trabeculectomy group at 3 months postoperatively.3.The effect of Phaco-IOL-GSL group and phacoemulsification group on the function of the meibomian gland was very small,while the phacotrabeculectomy group and the trabeculectomy group still showed the deficiency of the severe meibomian gland duct and meibomian gland dysfunction at 3 months postoperatively.The above two findings suggest that the reduction of intraocular pressure for Phaco-IOL-GSL group is more ideal,and the effect of tear film stability and meibomian gland function is minimal.Patients for primary glaucoma combined with cataract choose Phaco-IOL-GSL surgery under the condition of illness license priority...