Trabeculectomy For Primary Acute Angle-Closure Glaucoma With Persistent High Intraocular Pressure By Ultrasound Biomicroscopy

Objective:Primary acute angle-closure glaucoma is one of the most common acute eye diseases in our country。In clinic,it is often observed that the intraocular pressure (IOP)of primary acute angle-closure glaucoma increases sharply even if multiple remedies are used adequately and actively. So trabeculectomy had to be performed with high IOP eye. This study is to analyze the dangerous of complications such as cyclodialysis and shallow anterior chamber by ultrasound biomicroscopy (UBM) , and to evaluate the efficacy and safety of the surgery with high IOP.Methods:Retrospective analyzed 56 cases (60 eyes) of primary acute angle-closure glaucoma, which received trabeculectomy. These cases were divided into 2 groups by the preoperational IOP value after 72 hours in hospital. The high IOP group:30 cases (30 eyes), IOP≥40mmHg (1mmHg =0.133kPa), male 7, female 23, the average age 61.9±7.2 years old, the time of persistent high IOP 2—16 days, average time 5 days ,the best correct visual acuity (BSCVA) hand motions—0.25;The control group: 26 cases (30 eyes), IOP<40mmHg, male 9 cases (9 eyes) , female 17 cases (21 eyes), the average age 59.4±7.6 years old, the time of persistent normal IOP 2—10 days, average time 3 days, BSCVA 0.12—0.6. Both groups were performed trabeculectomy after 72 hours in hospital. And routine examinations such as slit-lamp biomicroscope and ophthalmoscope, IOP, BSCVA and measurements of relative parameters (ACD, AOD500, TIA,TCPD,IT1 and so on.) by UBM were observed, complications and surgery outcome of both groups were analyzed by SPSS11.5 statistically.Results:No severe complications such as choroidal hemorrhage andmalignant glaucoma were observed in all cases during surgery and postoperatively. The postoperative VA of high IOP group improved except 2 cases that the preoperative high IOP persistent times were too long for respective 16 days and 20days, and most patients gained a better vision. The VA of the control group remained unchanged mostly and there were 2 cases of the control group that the VA became worse because of hypotony maculopathy. The IOP were controlled between 7 to 16 mmHg after surgery. Cyclodialysis was observed in 1 case of high IOP group and 2 cases of the control group without significant difference (p>0.05). The few postoperative complications such as iritis, shallow anterior chamber, anterior chamber hemorrhage and hypotony maculopathy were observed in both groups without significant difference by Fisher′s accurate probability analysis (p>0.05). Parcel filterable blebs were observed in respective 2 cases of both groups. Through bleb needling and 5-Fu subconjunctival injection, the result was satisfactory.Conclusions: Trabeculectomy for primary acute angle-closure glaucoma with persistent high intraocular pressure is safe and effective. To keep the visual function from more damage, trabeculectomy should be performed for these patients promptly after using adequate remedies. UBM is good to find cyclodialysis and anterior choriodal shallow detachment which conventional scan ultrasound can′t collect. UBM is very important for instructing the therapy of glaucoma preoperatively and postoperatively, and is suggested to be as a routine examination before and after surgery in glaucoma.