Experimental And Clinical Study Of Combining Phacoemulsification With Endoscopic Cyclophotocoagulation To Manage Cataract And Glaucoma

ObjectivesExperimental study：1．To explore the ciliary body histopathological changesafter ECP+Phaco+IOL surgery;Analysis the relationship of laser photocoagulationciliary body tissue destruction with aqueous humor secretion、inflammatory respo-nse．Analysis the change of Concentration about aqueous humor of protein、TNF-α、IL-1βafter the two surgery for glaucoma combined with cataract2．Discussion effect of the ECP+Phaco surgery reduces IOP．Anal-ysis of thecorrelation of the cyclophotocoagulation range and reduce IOP．provide the referencefor clinical application．Clinical study：To Compare the Intraocular pressure(IOP) lowering effect、visual acuity、corneal endothelial cell number、 intraoperative and postoperative rateof complication in ECP+Phaco+IOL and TRAB+Phaco+IOL two surgery forglaucoma combined with cataract．MethodExperimental study：24gray rabbit48eyes successfully established chronicglaucoma were randomly divided into group A、B、C、D total of four groups． Wheregroup，A、B、C were given180°、270°360°three different range of cyclophotocoag-ulation in ECP+Phaco+IOL combined surgery．Group D was treated with TRAB+Phaco+IOL．Respectively comparative analysis including：IOP lowering effect;preoperative and postoperative aqueous humor of protein、TNF-α、IL-1βcontentdetection; anterior chamber reacti-on after surgery， rates of intraoperat-ive andpostoperative complicat-ions．And examination for histopathological of ciliary body．Clinical study：52cases (60eyes) cataract and glaucoma patients divided intofor two groups combined surgery． Group I：22cases (26eyes) combined ECP+Phaco+IOL surgery; Group II：30cases (34eyes) combined TRAB+Phaco+IOLsurgery．Compare the two combined surgery patients change of IOP、visual acuity、corneal endothelial cell count with preoperative and post-operative． And observedanterior chamber inflammation、IOL position、 intra-operative and post-operative complications after the two combined surgery;All patients were followed-up from6to13months(mean9．3months)．ResultsExperimental study：1．30gray rabbit (60) were used532-the diode laserlimbal small beam net production of chronic ocular hypertension model， modelingsuccess rate of83．33%．2． For group A， group B， group C and D IOP comparison at each time pointafter operative： The1st day IOP respectively17．38±6．04mmHg，14．52±4．83mmHg，10．17±3．39mmHg，13．05±5．05，P=0．008，comparison groupsA and C，groups A and D， groups B and C， respectively were： PAC=0．001、PAD=0．037、PBC=0．035． The1st week IOP respectively：16．39±5．17mmHg、14．07±2．96mmHg、11．58±2．11mmHg、14．45±6．30mmHg，P＝0．090，comparison groups A and C was PAC＝0．013． The2nd week IOP respectively：16．35±3．64mmHg、15．07±2．54mmHg、10．73±2．47mmHg、13．55±4．81mmHg、P＝0．003，comparison groups A and C，groups Band C respectively were：PAC＝0．0018、PBC＝0．006．The1st month IOP respectively：5．48±3．57mmHg、14．36±3．23mmHg、10．68±2．62mmHg、13．81±3．37mmHg，P＝0．006，comparison groups A and C， groupsB and C， groups C and D， respectively were：PAC＝0．001、PBC＝0．009、PCD＝0．026． The3rd month IOP respectively：15．64±3．87mmHg、13．95±3．11mmHg、10．92±3．17mmHg、14．10±3．98mmHg，P＝0．048，comparison groups A and C was：PAC＝0．008．The6th monthIOP respectively：15．05±4．97mmHg、12．94±3．33mmHg、10．17±2．43mmHg、14．09±6．03mmHg、P＝0．075，comparison groups A and C was： PAC＝0．011． Group A， group B， group C， group D within each group at each timepoint after operative comparison preoperative IOP using Dunnett-t test， P <0．05．3．Group A， group B， group C， group D each of preoperative and postopera-tive time points IOP reduce comparison： The1st day comparison groups A and Cwas：PAC＝0．013，Among other groups P>0．05．The1st week comparison amongall the groups P>0．05．The2nd week comparison groups A and C， groups B and Cwere statistically significant， respectively for PAC＝0．018，PBC＝0．014．The1stmonth comparison groups A and C， groups B and C were statistically significant， respectively for PAC＝0．024，PBC＝0．016．The3rd month comparison：among allthe groups P>0．05．The6th month comparison：among all the groups P>0．05．360°than180°range of IOP reduced was steeper for ECP rabbit eyes with glaucoma．4．Group A， group B， group C， group D preoperative and after operative the1st day，1st week，2nd week，1st month detected aqueous humor：Protein concentra-tion detection no statistically significant difference between the groups at each timepoint P>0．05．After operative all groups aqueous humor protein concentrationreached a peak on1st day，and then gradually decreased，and on1st month reach thepreoperative levels．TNF-αconcentration detection no statistically significant differen-ce between the groups at each time point P>0．05After operative all groups aqueoushumor protein concentration reached a peak on1st week，and then gradually decrea-sed，and on1st month reach the preoperative levels．IL-1β concentration detection nostatistically significant difference between the groups at each time point P>0．05．After operative all groups aqueous humor protein concentration reached a peakon2nd week，and then gradually decreased，and on1st month reach the preoperativelevels．5．Postoperative anterior chamber reaction with slit lamp： The most eyes afteroperative on1st day and1st week anterior chamber reaction1+to2+， group B，group C and group D， each with have one eye4+anterior chamber fibrin exudationfiber membrane reaction；After3-6months the majority of anterior chamber reaction，from0to1+，and group D still has one eye anterior chamber reaction get3+． Intraopera-tive and postoperative complication： observed1st month afteroperative，group A of2eyes、 group B and D each had1eye emerged high IOP，group C3eyes D group a low intraocular pressure，Group C3eyes and group D1eyeemerged low IOP．Intraoperative and postoperative all groups were not arised seriouscomplications as if fulminant choroidal hemorrhage， intraocular lens dislocation，retinal or choroidal detachment， endophthalmitis etc．6．ECP+Phaco+IOL after6months examined ciliary body histopathology：foundthe ciliary body distortions、contracture、normal structure disappeared，No pigmentepithelial shedding and focal missing，the disordered structure of the pigmentepithelium epithelial cell necrosis， depigmentation;No pigment epithelial shedding and focal missing; pigment epithelial structural disorder and necrosis， depigmen-tation; Ciliary body stromal edema，coagulation necrosis，vacuolization of changeand visibled endovascular erythrocytes agglomerated; No obvioued organizationschange where outside the photocoagulation regional morphology and tissue．Clinical study：Postoperative visual acuity≥0．3were：groupⅠ53．85%，groupⅡ38．24%．The improvement of visual acuity when the last review were：groupⅠ84．62%， groupⅡ67．65%． The post-operative mean IOP were：groupⅠ13．82±3．81mmHg (1mmHg=0．133kPa)， groupⅡ14．81±3．64mmHg． Both groups compared with pre-operative significant difference (P<0．05)． Two groups combined surgery preoperative and post-operative cornealendothelial cell count was no significant difference． None of the group I and groupII intraoperative and postoperative were not arised serious complications such as：fulminant choroidal hemorrhage、 intraocular lens dislocation、 retinal or choroidaldetachment、 endophthalmitis etc．ConclusionExperimental study：1．Both the glaucoma and cataract surgical approach caneffectively reduce IOP on chronic glaucoma， In ECP+Phaco+IOL joint surgerythree groups：180°、270°、360°different Cyclophotocoagulation range，Postoperative lower IOP related： the photocoagulation range greater degree， thegreater the reduction of intraocular pressure;But the range of360°Cyclophotoc-oagulation did not cause ocular atrophy． The reason may be that the laserphotocoagulation is impossible to destroy all the cells of all the ciliary processes，andhaven’t damaged epithelial cells still secretion of aqueous humor．We observedCyclophotocoagulation ciliary body preferably IOP control in the range of180°and270°．2．Group A、group B、group C and group D after1st day，1st week，2nd weekthere are varying degrees of anterior chamber reaction， Aqueous humor elevatedlevels of protein，TNF-α and IL-1β，To preoperative levels decreased substantiallyafter1month， No significant difference between in the each group at the each ofpostoperative point-in-time， Both combining surgeries， a different range ofCyclophotocoagulation has little effection of protein concentration、 TNF-α and IL-1βcontent．3． ECP ciliary processes normal structure disappeared； without pigmentepithelium and focal absence；and pigment epithelial cell disorders、necrosis、depigmentation may be caused by the reasons for reducted formation of aqueoushumor．4．The both combining surgeries were not arised serious complications onintraoperative and postoperative．Clinicians can choice combining surgery procedureaccording to the condition of the disease、 preoperative IOP and the mastery of thesurgical approach．Clinical study：Both glaucoma and cataract surgeries can effectively treatglaucoma associated with cataract． Can effectively reduce IOP and improve vision，ECP+Phaco+IOL is a treatment for glaucoma and cataract new combined surgery，The Postoperative don’t observe the glaucoma filtration blebs case，But its long-termeffects and postoperative complications may arise need a larger sample size andlonger observation and research．...