Discussion About Causes,Influence Factors And Treatment Of The Shallow Anterior Chamber After Surgery On Acute Angle-closure Glaucoma

Shallow anterior chamber is one of the most common complications after the trabeculectomy for the closed-angle glaucoma. Shallow anterior chamber can cause a series of adverse consequences, such as a failing surgery and abnormity of intraocular organizational structure, both of which can impact the visual function. To the worse, shallow anterior chamber can lead to corneal endothelial cell damage, inconvertible corneal endothelial discompensation, cataract, a failing glaucoma surgery and the iris adherent to the cornea, as while as a series of serious complications. In order to find the reason why the shallow anterior chamber appears after the trabeculectomy for the acute-angle-close glaucoma,discuss how to avoid adverse factors, achieve reduction in shallow anterior chamber,and find how to deal with shallow anterior chamber correctly, we collect 188 examples(198eyes) acute-closed-angle-glaucoma patients'postoperative observation and therapic data,and try our best to make a analysis and sum up the reason,influence factors and therapy for the shallow anterior chamber.Objective:To discuss the reason, influence factors and therapy for the shallow anterior chamber which appears after the acute- closed- angle- glaucoma patients'trabeculectomy.Methods: We analyze retrospectively from January 2006 to December 2007,of 188 examples (198 eyes) operated on trabeculectomy by a senior ophthalmology professor in department of glaucoma,NO.2 clinical hospital,Jilin university. 1.Try to analyze the causes of shallow anterior chamber; 2.discuss the influence factors.According to the preoperative condition of the iris, we group the eyes into group A and group B.Group A: 76 examples (78 eyes),the pupil acts restrictedly before the operation, and the irisposterior synechiae is serious or complete.Group B: 112 examples (120 eyes) ,the pupil acts unrestrictedly,loss of irisposterior synechiae or only just a little.Then we compared the incidence rate of the postoperative shallow anterior chamber between the two groups. According to preoperative ocular pressure,we divide group A into A1 and A2,Group A1: 26 examples (27 eyes), preoperative IOP > 30 mmHg; Group A2: 50 examples (51 eyes), preoperative IOP <=30 mmHg. Then we compare incidence rate of the postoperative shallow anterior chamber between Group A1 and Group A2. Following the same method,we divide group B into B1 and B2,Group B1: 49 examples (52 eyes), preoperative IOP>30 mmHg; Group B2: 63 examples (68 eyes), preoperative IOP<=30mmHg. Then we compare incidence rate of the postoperative shallow anterior chamber between Group B1 and Group B2.3. We sum up the treatment of the shallow anterior chamber.Results: 1.There are 48 examples (54 eyes) that turn up with shallow anterior chamber after the trabeculectomy,with an incidence rate of 27.27%,.There are 22 eyes of shallowⅠanterior chamber, accounting for 40.74%, and 23 eyes of shallowⅡanterior chamber, accounting for 42.59%, and 9 eyes of shallowⅢanterior chamber,accounting for 6.67%.Shallow anterior chamber always shows up in the second or the third day after the trabeculectomy,mainly because of hyper-filtration,leakage of conjunctiva, detachment of choroids,and malignant glaucoma, and above all, hyper-filtration is the most one,accounting for 79.63 %. 2. There is no statistical difference in age,gender,and preoperative IOP between Group A and Group B.There are 28 eyes which show up with shallow anterior chamber after the trabeculectomy,accounting for 35.90%,and there are 26 eyes which show up with shallow anterior chamber after the trabeculectomy,accounting for 21.67%.There is significant statistical difference between the two groups(χ2=4.827, P<0.05). 3.There is no statistical difference in age and gender between Group A1 and Group A2.The average preoperative IOP of Group A1 is (44.46±8.20) mmHg,and the average preoperative IOP of Group A2 is (19.04±6.80) mmHg.Through the T-test , there is significant statistical difference in preoperative IOP between the two groups (t =10.272, P <0.05). The average postoperative IOP of Group A1 is (12.76±5.48)mmHg, the average postoperative IOP of Group A2 is (12.58±4.46) mmHg.Through the T-test,there is no statistical difference (t = 0.118, P> 0.05).The descender of IOP is (31.69±12.66) mmHg in group A1 after the trabeculectomy,and the descender of IOP is (6.46±5.71) mmHg in group A2 after the trabeculectomy.There is significant statistical difference between the two groups(t = 8.633, P <0.05). There are 14 eyes which turn up with shallow anterior chamber after the trabeculectomy in Group A1,accounting for (51.85%),and there are 14 eyes which turn up with shallow anterior chamber after the trabeculectomy in Group A2,accounting for (27.45%).Through the chi-square test, there is significant statistical difference between the two groups (χ2= 4.568, P <0.05), and the incidence rate of shallow anterior chamber in Group A1 is higher than that in Group A2.4. There is no statistical difference in age and gender between Group B1 and Group B2.The average preoperative IOP of Group B1 is (48.27±6.26)mmHg,and the average preoperative IOP of GroupB2 is (20.44±6.02)mmHg.Through the t-test,there is significant statistical difference in preoperative IOP between the two groups (t=17.441,P<0.05). The average postoperative IOP of Group B1 is (14.35±3.55)mmHg, the average postoperative IOP of Group B2 is (12.71±3.83)mmHg.Through the T test,there is no statistical difference (t=1.696,P>0.05).The descender of IOP is(33.92±7.05)mmHg in group B1 after the trabeculectomy,and the descender of IOP is (7.09±6.61) mmHg in group B2 after the trabeculectomy.Through the T-test,there is significant statistical difference between the two groups(t=15.140, P<0.05). There are 16 eyes which turn up with shallow anterior chamber after the trabeculectomy in Group B1,accounting for (30.76%),and there are 10 eyes which turn up with shallow anterior chamber after the trabeculectomy in GroupB2,accounting for (14.71%).Through the chi-square test, there is significant statistical difference between the two groups (χ2=4.480,P < 0.05),and the incidence rate of shallow anterior chamber in Group B1 is higher than that in Group B2. 5. Through the conservative treatment,38 eyes are cured whose shallow anterior chamber is because of hyper-filtration,accounting for 88.37%, and 5 eyes whose shallow anterior chamber is because of hyper-filtration are cured by surgery associated with medicine treatment,accounting for 11.63%. Through the conservative treatment,5 eyes are cured whose shallow anterior chamber is because of leakage of conjunctiva ,accounting for 71.43%,and 2 eyes whose shallow anterior chamber is because of leakage of conjunctiva are cured by surgery associated with medicine treatment,accounting for 28.57%.2 eyes are cured by surgery associated with medicine treatment whose shallow anterior chamber is because of detachment of choroids,accounting for 33.33%,1 eye is cured by conservative treatment whose shallow anterior chamber is because of detachment of choroids,accounting for 66.67%.The conservative treatment does not work to the only 1 shallow anterior chamber which is because of malignant glaucoma,but the surgery works.Conclusions: 1. Postoperative shallow anterior chamber is mainly because of hyper-filtration,leakage of conjunctiva, detachment of choroids and malignant glaucoma. 2. The higher the preoperative IOP is,the more the descender of IOP after the trabeculectomy is,and the higher the incidence rate of shallow anterior chamber is. 3. The preoperative condition of pupil can impact the incidence rate of postoperative shallow anterior chamber.Bad irisposterior synechiae and less activity of pupil can result in postoperative shallow anterior chamber. 4. Majority of shallow anterior chamber can be cured by conservative treatment,but minority must be cured by surgery associated with medicine treatment. 5. Although shallow anterior chamber is inevitable after the trabeculectomy,but if we do things right before,after and in the trabeculectomy,we can reduce the incidence rate effectively.