The Efficacy Analysis Of Medication In The Treatment Of Old Pirmary Chronic Angle-closure Glaucoma(CACG) Patients

Since the intra-ocular pressure (IOP) in chronic angle closure glaucoma patient is risegradually, the most efficient way to control IOP is just to reduce the pressure, and toalleviate damage to the retinal nerves. American Academy of Ophthalmology recommendsthe laser peripheral iridotomy as the first choice for CACG patients, because of itsharmlessness, briefness and less complication. Medicine can be used in local when the IOPhas not been reduced after LPI. If still useless, filterable surgery can be taken, such as thetrabeculectomy. The connective strategy of “LPI-medicine-surgery” has been acceptedextensively in the world, not in China. Currently, trabeculectomy has reduced by70%, from1996to2006, in western countries. It is believed that new drugs contribute greatly tothechange. The attention to the medicine for CACG patients is still insufficient.That’s ourconcern.We choose old, no evident symptomatic, unconspicuous-IOP-upward(less than35mmHg) patients as our subject.33CACG patients,male22and female11，with66eyes,treated in the first affiliated hospital of Jilin university from June2007to June2008werechose. With individualized medicine and regularly follow-up visit, we try to confirm thefeasibility of medicine in reducing the IOP and damage to the retinal nerves in CACGpatients.IOP，retinal nerve fibre layer (RNFL) thickness, Cup/Disc horizontal ratio(C/D) andvisual field were chose and investigated. In medicine team, patients were treated distingui-shingly according the peak IOP，duration of peak IOP，fluctuation range of IOP and validtime. Applications of ophthal-motonometer, OCT and Humphrey perimeter were accorded tothe specification respectively, and were used to detect the parameters’ differences.Reexaminations were done for each six-month interval and the whole follow-up visitsproceed for three years. Paired-Sample t Tests were used to complete the statistical analysiswith the dates which were collected six month，one year，two year and three year after medi-cine, respectively.Clinic date showed that the descent value range of IOP between5.46～5.32mmHg indifferent check points and the below fluctuation among26.56﹪～27.26﹪contrast to the initial numbers. The t values in four check points were11.955、12.103、11.598、11.588,respectively, and the descent of IOP is significant(P<0.05). The damage of visual field: side-ward scotomas36eyes, naso-lateral step16eyes, arched scotomas8eyes and annular visualdamage6eyes. After reviews, they were34eyes,16eyes,10eyes and6eyes correspondingly.The t value MD is-0.965、1.243、-1.350、-1.371.For PSD, they were1.434、1.454、1.821、1.88. Some damages were did happened but the difference is not significant (P<0.05). Wealso found that variation of RNFL, it were thinner in different quadrants, but thestatisticalanalysis showed that the difference had no significance value.(P>0.05). Furthermore, samevariation tendency were found in C/D ratios. Thus, we can get the conclusion that the opticnerve hadn’t been damaged evidently after three years reviews.In the statistics analysises, we got P <0.01for IOP’s alteration. However, for otherparameters, the P value had always been lager than0.05, regardless of RNFL thickness, C/Dor visual field. In other word, the changes of RNFL thickness, C/D and visual field didn’thave statistical significance.In summary, from our investigation, we can draw the conclusion that individualizedmedicine treatment can cure the CACG patients without obvious IOP and evident symptoms,independently. More observations included vast samples are needed in order to confirmlong-range efficacy. Nevertheless, we have offered a new choice for some CACG patients,obviously.