| It showes that lens playes an important role of the pathogeny of angle closure glaucoma recently. The lens turns thinker and larger with aging and aggravates pupillary block. Meantime, the incidence of cataract increases and the combined cataract and angle closure glaucoma increases. Hie surgical strategies don' t agree . It ' s studied which to select: glaucoma procedure alone, combined cataract and glaucoma operation or catarant operation alone. With the Umits of examining technology, there were no way to measure the angle structure, and the evaluation of glaucoma operation lacks quantitive index. The use of ultrasound biomicroscopy ( UBM ) in ophthomologic clinic makes it probable. We underwent glaucoma operation alone and combined cataract and glaucoma operation separat-ly on combined cataract and primary angle - closure glaucoma ( PACG) preoper-atively and postoperatively, angle and its related structures were measured by UBM and analyzed in order to inquire the effect of operation on angle, and make clear the effect of lens extraction on angle structure of angle - closure glaucoma by contrast analysis. References of surgical choices of combined cataract and glaucoma will be offered.Materials and methodsClinical materials:32 patients (40 eyes) combined cataract and primary angle - closure glaucoma were paired into two groups by age, sex, state of glaucoma and cataract. Group A underwent underlamellar trabeculectomy. Group B underwent combined cataract and glaucoma and intraocular lens (IOL) implantation. 14 patients (20 eyes) were in group A (6 male,8 female) , aged 57 -79( mean 67.9 6.3) years. 18 patients (20eyes) were in group B (7male,ll fe-male) , aged 50 -79( mean 67.4 7.9) years. 16 eyes with acute and 24 eyes with chronic types of PACG, paired into two groups. Measure methods: anterior chamber depth ( ACD) , angle opening distance at 500 microm from the spur (AOD500) , trabecular - iris angle ( TIA) , trabecular - ciliary process distance (TCPD) , iris distance (IDI) were determined quantitively by using UBM according to Pavlin before and one month after surgery. The quantitive materials were underwent paired t - test.RESULTSIn group A, there were no statistically significant differences between the preoperative and postoperative ACD, AOD500, TIA, TCPD ( t = 0. 964, p = 0.347;t= - 1.652, p =0. 115; t = - 2. 071 ,p = 0. 052; t = -1.409,p = 0. 175). In group B. There were statistically significant differences between the preoperative and postoperative ACD, AOD500,TIA,TCPD (t = - 19. 061 ,p = 0.000;t= -9.505,p=0.000;t = - 10. 971,p =0. 000;t = -6.988,p = 0.000). There were statistically differences of post/pre - operative remainder of ACD, AOD500, TIA, TCPD between group A and B. There was no statistically differences between the preoperative and postoperative IDI in group A ( t = - 1.977,p =0.063) and B (t =0. 128,p =0. 899). There was no statistical difference of post/pre - operative remainder of IDI among the two groups (t = -1.751,p=0.097).Conclusions1. The lens is the main factor causing papillary block. Lens extraction may remove the lenticular factor of pathogenesis in PACG.2. The central anterior chamber deepens over and over by lens extraction .3. The anterior chamber angle deepens, trabecula reopens by lens extrac-tion.4. The ciliary body is located posteriorly by lens extraction.5. Lens extraction has an important effect on angle and its related structure in angle closure glaucoma, so we suggest that combined cataract and glaucoma surgery be the better choice when faced with coexisting cataract and glaucoma.
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