The Clinical Effect Of Combined Surgery On Acute Primary Angle-closure Glaucoma With Cataract

Objective: To evaluate the clinical effect of phacoemulsificationcombined with goniosynechialysis and phacoemulsification combined withtrabeculectomy on acute primary angle-closure glaucoma with cataract.Objects and methods:40cases of primary acute angle-closure glaucomapatients from March2011to March2012in our hospital （40eyes）, including14males （14eye）,26women （26eye）, were chosen for the study. Caseselection standard:1Clinical diagnosis of patients with primary acuteangle-closure glaucoma with cataract（exclude traumatic cataract and cataractoverripe period）;2No other eye diseases such as old rainbow eyelashesinflammation, exfoliation syndrome, neovascular glaucoma secondary toocular trauma or uveitis, glaucoma, iridocorneal endothelial syndrome;3Nocontraindications and serious systemic diseases;4The patients and familymembers were informed and consent with this treatment and surgery. The40patients were paired into two groups by age, gender, state of glaucoma andcataract．20eyes were done phacoemulsification implanted artificial crystalcombined with goniosynechialysis （hereinafter referred to as thegoniosynechialysis group）,20eyes were done phacoemulsification implantedartificial crystal combined with trabeculectomy （hereinafter referred to as thetrabecular group）; through the observation of two different groups of patientswith visual acuity, intraocular pressure（IOP）, complications and UBM relatedindicators: anterior chamber depth（ACD）, angle opening distance at500microm from the scleral spur（AOD5OO） and trabecular-ciliary process distance（TCPD）, the follow-up time was6months¹year. All data used the SPSS13.0software for statistical analysis, The measurement data were expressed withthe mean value±standard deviation （（x|-）±s）, independent samples t test forcomparison between different groups, and paired samples t-test for comparison between preoperative and postoperative in the same surgery;Count data used the chi-square test, P<0.05was the difference which had thestatistical significance.Results:1Baseline comparison: In the gender, age, visual acuity, intraocular pressure,and the anterior chamber depth（ACD）, angle opening distance at500micromfrom the scleral spur（AOD5OO） and trabecular-ciliary process distance （TCPD）indicators of the goniosynechialysis group and the trabecular group showed nostatistical significance（P>0.05）.2Visual acuity: The comparison between preoperative and postoperativevisual acuity of the goniosynechialysis group and the trabecular group wasstatistically significant （P<0.05）. The comparison between postoperativevisual acuity of the goniosynechialysis group and the trabecular group was notstatistically significant （P＞0.05）. Two surgical ways could enhance the vision,and the vision enhanced effect was undifferentiated.3Intraocular pressure: Preoperative IOP was22.±3.197mmHg, postoperativeIOP was17.15±1.694mmHg in the goniosynechialysis group, the differencewas statistically significant（P<0.05）； preoperative IOP was21.9±3.385mmHg, postoperative IOP was14.7±1.688mmHg in the trabecular group, thedifference was statistically significant （P<0.05）, two surgical methods bothgood to IOP control. The reduction of IOP was5.15±2.924mmHg in thegoniosynechialysis group, and the reduction of IOP was7.2±2.802mmHg inthe trabecular group. The difference was statistically significant （P<0.05）. Thetrabecular group IOP reduced effect was superior to the goniosynechialysisgroup.4UBM related indicators4.1Preoperative ACD was2.17±0.287mm, postoperative ACD was3.305±0.277mm in the goniosynechialysis group, the difference was statisticallysignificant（P<0.05）; preoperative ACD was2.159±0.275mm, postoperativeACD was3.083±0.228mm in the trabecular group, the difference was statistically significant（P<0.05）. The two surgical methods are good to deepenACD. The deepened magnitude of ACD was1.135±0.216mm in thegoniosynechialysis group, the deepened magnitude of ACD was0.924±0.239mm in trabecular group, the difference was statistically significant （P<0.05）, the goniosynechialysis group ACD deepen effect was superior to thetrabecular group.4.2Preoperative AOD₅₀₀ was0.087±0.011mm, postoperative AOD₅₀₀ was0.243±0.036mm in the goniosynechialysis group, the difference wasstatistically significant（P<0.05）; preoperative AOD₅₀₀ was0.089±0.012mm,postoperative AOD₅₀₀ was0.216±0.020mm in the trabecular group, thedifference was statistically significant（P<0.05）. The two surgical methods aregood to enlarge AOD₅₀₀. The enlarged magnitude of AOD₅₀₀ was0.155±0.033mm in goniosynechialysis group, the enlarged magnitude of AOD₅₀₀was0.127±0.012mm in trabecular group, the difference was statisticallysignificant（P<0.05）, the goniosynechialysis group AOD₅₀₀ enlarged effectwas superior to the trabecular group.4.3Preoperative TCPD was0.631±0.106mm, postoperative TCPD was0.965±0.100mm in the goniosynechialysis group, the difference was statisticallysignificant（P<0.05）; preoperative TCPD was0.607±0.109mm, postoperativeTCPD was0.855±0.093mm in the trabecular group, the difference wasstatistically significant（P<0.05）, two surgical methods both good to enlargeTCPD. The enlarged magnitude of TCPD was0.334±0.054mm in thegoniosynechialysis group, the enlarged magnitude of TCPD was0.248±0.075mm in the trabecular group, the difference was statisticallysignificant（P<0.05）, the goniosynechialysis group TCPD enlarged effect wassuperior to The trabecular group.5The postoperative complications: All patients didn’t suffer from seriouscomplications such as retinal detachment or malignant glaucoma,postoperativecorneal edema had2eyes （10%） in goniosynechialysis group,2eyes （10%） intrabecular group; Iris cellulose sample oozy had2eyes （10%） ingoniosynechialysis group,5eyes （25%） in trabecular group; postoperative shallow anterior chamber had0eye （0%） in goniosynechialysis group,3eyes（15%） in trabecular group; Conjunctival follicular leakage had0eye （0%） ingoniosynechialysis group,4eyes （20%） in trabecular group; the pupil artificialcrystal adhesion had0eye （0%） in goniosynechialysis group,3eyes （15%） intrabecular group; the trabecular group postoperative complications were morethan the goniosynechialysis group.Conclusion:1Phacoemulsification combined with goniosynechialysist andphacoemulsification combined with rabeculectomy could remove the crystalblock factor from the pathogenesis in acute angle-closure glaucoma, and theywere safe and effective methods for the treatment of acute primaryangle-closure glaucoma with cataract.2As to the visual acuity improved effect, there was no differencebetween the goniosynechialysis group and the trabecular group; in theintraocular pressure reduced effect the trabecular group was superior to thegoniosynechialysis group; the goniosynechialysis group was better than thetrabecular group in the improved effect of anterior chamber structure such asdeepen ACD, increased AOD₅₀₀and TCPD.3The postoperative complications of the goniosynechialysis group wereobviously less than that of the trabecular group.