A Clinical Analysis Of Phacoemulsification Uniting Goniosynechialysis To Cure Cataract Complicating Angle Closure Glaucoma

Glaucoma is the most common agent leading to nonreversible blind in theworld. Risk factors about glaucoma include race of people, female, advancedage, abnomal anatomy (shallow of anterior chamber, microcornea, lensthickening), exofoliation syndrome, certain drugs touching. Recently, accordingto its nosogenesis, domestic scholars divide primary closed-angle glaucoma intothree types: simple pupil block, simple non-pupil block and combinedmechanism. Simple no-pupil block is also called folding iris, scarcely seen inour country, only 0.7% primary closed-angle glaucoma belonging to this type,and combined mechanism accounting to 54.8%.During the course of catract, crystalline humor dilating, anteroposteriordiameter accreting, its locating antedisplacement, all these factors make thecontact face of crystalline humor and iridal augmentation, and then aqua oculi inPC excluding from pupil to AC gradually become difficult, which shaped pupilblock. When the plessure of PC becomes high enough to make ambitus ectasiairidis manifest, at last leads to the angle angusty and even closure. For thisreason, the incidence of cataract complicating angle closure glaucoma is veryhigh.At first, the operation to cure cataract complicating angle closure glaucomais usually to remove cataract outside the bladder, embedding IOL uniting oculartrabeculectomy. In these years, this problem has become argument in departmentof ophthalmology. With the operation cataract emulsification using hypersoundbecoming popular, its forte of stable postoperative intraocular tension,diminutive astigmatism and tissue damage, regaining acuteness of visionenables this technique replace the removement of cataract outside the bladder.As the surgical apparatus and techniques becoming flawless, effectivenesselevating, complications tapering, it's possible to cure angle-closure glaucomaby the operation of phacoemulsification. According to recent report: lensremoval uniting IOL implating, angle synechiolysis, and phacoemulsificationwith goniosynechialys (abbreviating PEGS) can successfully degrading thetension of eyeball of angle-cosure glaucoma patient.Objective to approach the effectiveness of phacoemulsification withfolding intraocular lens implantation combining/ non-combining anglesynechiolysis at a clearing comea cut to cure cataract complicating angle closureglaucoma.Method from March 2004 to January 2005, we chose 31 patients (33eyes ) not to be in hospital with cataract complicating angle closure glaucoma,12 male( 12 eyes ), 19 female (21eyes, with both eyes of two patients ),averaged 67.29±7.95 (ranged 51～83 ) years old.31 patients were randomly divided into two groups: in group A, at aclearing comea cut, phacoemulsification with folding intraocular lensimplantation, account to 17 patients (17 eyes);in group B,at a clearing comeacut, phacoemulsification with folding intraocular lens implantation combininggoniosynechialys, using ixo-rebound and irrigation to blunt dissect thegoniosynechia, account to 16 patients ( 16 eyes ). Two patients' four eyes wererandomly divided into two groups.Using slit lamp microscope and funduscopyto deplete hypermature stage, traumatic cataract, uveitis (such as Fuchssymptom complex), secondary glaucoma, secondary glaucoma after ocularinjury, neovascular glaucoma and iridocorneal endothedial syndrome.20.5±2.79 months following-up visit, on the first day, second day, third day,first week, first month, sixth month and the final visit, we measured tension ofeyeball, record the types of drug to lower the intra-ocular tension and observedpostoperative complications;we also checked the closure scope ofgoniosynechia using goniolens on the first month and the last visit ( afteroperation ).Result 31 patients (33 eyes) were included in follow-up visit, 20 patients(32 eyes ) finished in research, with 16 patients ( 16 eyes ) but one male patientlost in group A, 16 patients (16 eyes) in group B. There were no differencebetween two groups on general state of health (before operation), averagetension of eyeball, types of drug to lower the intra-ocular tension and the besteyesight.On the last visit, the average tension of eyeball in group A degradedsignificantly and the difference was obviously ( with t match test, t=2.816 P﹤0.05 ). In group B, on the last visit the same result happened, with obviousdifference, (with t match test, t=5.505 P﹤0.001 ).The average tension of eyeball in three days after operation in group B waslower than that in group A with obvious difference (P﹤0.05 );the same resulthappened on the first week, first month, six month after operation, but thedifference was insignificant (P﹥0.05 );on the last visit, results in group B weresignificant lower than that in group A, with obviously difference (P﹤0.05 ).And the decrease of tension of eyeball in group B was larger than that in groupA compared between last visit and preoperation, and the difference wassignificant (P﹤0.05 ).The types of drug to decrease the tension of eyeball diminished obviouslyin both groups on the last visit, with significant difference (t match test,P﹤0.001).Six months after operation, the best eyesight of the eyes more than 0.5 were28, 13 eyes in group A (81.2%), 15 eyes in group B (93.8%), with no obviousdifference between two groups (x2=0.286,P﹥0.05).Checked with goniolens a month after operation, all patients' angle ofanterior chamber angle reopened to certain degree, chamber angle reopenedfully: 10 eyes (62.5%) in group B, no eyes (0%) in group A, obviously, thedifference was great and significant (x2=11.782, P﹤0.05). There was one eyein group B with goniosynechia after operate and closed more than 180○, whichhad long case history (24 months after acute angle-closure glaucoma) andposterio-synechia, some bleeding in anterior chamber in operation. There weresix eyes in group A with goniosynechia after operate and closed more than 180○,included two eyes with dim chronic angle-closure glaucoma, one eye withchronic case history, one eye with acute history for three months, one eye withacute history for four months, one eye with acute history for sixmonths.Checked with goniolens on the last visit, there was no visible recloser inatrio-angle.There was no evident complication during operation, but four eyes (25%)had visible corneal bedewing, and diminished in a week. There was one eye(6.3%) with some bleeding in arterior-chamber during operate, and five eyes(31.2%) had visible corneal bedewing, also resolved in one week. There were nocomplications in two groups such as post-bladder disruption, ablatio retinae,malignant glaucoma.Conclusion with a clear cut in cornea, phacoemulsification with foldingIOL implantation and phacoemulsification with folding IOL implantationcombining goniosynechialys (PEGS) both can be modus operandi to curecataract.While, the effectiveness of atrio-angle reopened and the loss tension ofeyes, PEGS performs better than the other, and the concrete indication of twomethods still needs to be approached further more.