Phacoemulsification Postoperative Iop, Anterior Chamber Depth And Anterior Chamber Angle Changes In Addition To The Foldable Intraocular Lens Implantation

Purpose:Primary closed-angle glaucoma is equivalent to visceral wind cataract in Chinese ophthalmology,and is the main type for Chinese people.The morbidity rate rises with aging.With aging,the crystalline humor become thicker and moves forward which results in the narrowing angle of anterior chamber for those who has the PACG anatomy bases.Recently,the phacoemulsification with lens implantation is becoming more and more perfect,in order to study whether phacoemulsification with lens implantation can both improve the eyesight and prevent from PACG for those who have complications of shallow of anterior chamber and narrow chamber anterior of cataract and tend to have PACG.Patients who fit these conditions were randomly chosen to have this surgery.Method:1.27 cases of phacoemulsification with lens implantation in the out-patient department in Dong Zhimen Hospital from March,2008 to March,2009 were chosen.30 eyes,including 7 eyes of 6 males and 23 eyes of 21 female patients.The age was between 49-86 and the average was 71.23±10.11.The standard of cases were: turbid crystal,and eyesight below 0.5;2.angle of anterior chamber:level 1 to level 4;peripheral chamber depth＜1CT;normal ocular tension:8～21mmHg;expanded perimeter iris;patients' agreement.Operation method:after superficial anesthesia and retrobulbar anesthesia,sclerotic tunnel cut on 2.00mm of the conjunctiva away from the corneoscleral junction,keratonyxis on the transparent zone near the limbus corneae,then use 3.2mmparacentesis knife to stab into the nterior chamber,inject the medical Sodium Hyaluronate gel produced by Shanghai Qisheng biological agent limited company into anterior chamber,phacoemulsification with Diplomax machine by AMO American company,implant 6.0mmSensar lens by AMO company into the bag,clear Hyaluronate,the cut closes naturally.3.Course of treatment:60 days.4.Indexes: Observe the eyesight,flatten intra-ocular tension,and peripheral chamber depth on 6 o'clock before the surgery and 1day,7 days,15 days,1 month,2 months after the surgery. Observe the central anterior chamber depth and angle of anterior chamber width before the surgery and 1 month,2 months after the surgery.5.Statistical treatment:Use SAS 8.2.Use pair t test on the change of intra-ocular tension and central anterior chamber depth,and use X~2 Cochran-Mantel-Haenszel(X~2cmh) test on the changes of eyesight,angle of anterior chamber and peripheral chamber depth before and after the surgery.Result:1.Eyesight:X~2cmh test showed significant difference which means the eyesight of 30 eyes improved.2.Intra-ocular tension:Ignoring the influence of corneal thickness which is regarded as constant.The average intra-ocular tension of the 30 eyes were 16.03±2.36 mmHg before the surgery,and(16.83±4.42)mmHg after the surgery with no significant difference;it dropped to(14.97±3.59)mmHg 7 days after the surgery with significant difference compared to the tension before the surgery;the average intra-ocular tension 15 days,1 month,2 months after the surgery were(14.90±2.43) mmHg,(15.03±1.96)mmHg,(14.83±2.60)mmHg with significant difference(P=0.01).3.Central anterior chamber depth:Before the surgery it was(3.04±0.46) mm,and after the surgery it increased to(4.06±0.33) mm,(4.08±0.38)mm with significant difference after the t test.4.Peripheral chamber depth:The peripheral chamber depth of all the patients after the surgery≥1CT, with flat iris and no expansion on the perimeter.5.Angle of anterior chamber:There were different scales of narrow chamber angel,after the surgery,they all became wider and the narrow quadrant reopened with significant difference.6.Therapeutic effect:The effective rate of every observation indexes were:intra-ocular tension 56.67%,central anterior chamber depth 96.67%,peripheral chamber depth 100%,anodic angle of anterior chamber width 93.33%,temple angle of anterior chamber 93.33%.Conclusion:Phacoemulsification with lens implantation can not only improve the eyesight of patients with shallow anterior chamber and narrow chamber angle accompanied by cataract,but also can deepen the central and perimeter chamber,widen the chamber angle and lower the intra-ocular tension and therefore prevent from PACG. This surgery has good therapeutic effects and little complications and is worth studying.