Investigation Of Phacoemulsification Combined With Goniosynechialysis Operation On Intractable Angle-closure Glaucoma Treatment

Purpose:Observeinvestigation of phacoemulsification and intraocular lens implantation combined with Goniosynechialysisperation on intractable angle-closure glaucoma whose IOP can't be controlled after trabeculectomy.Methods:This study is a retrospective,self-controll study.Collected from April,2015 to August,2016 in Shenyang Heshi ophthalmic hospital,14 eyes of 12 patients were selected.Among which 2 cases(2 eyes)were males and 10 cases(12 eyes)were females.Selection criteria:Comply with the criteria for the diagnosis of angle-closure glaucoma.The eye of surgery had a history of trabeculectomy,with different degree of optic nerve damage and visual field defect.Scope of corner adhesion were more than 270 degree.The anterior chamber was closed or narrow by UBM and shallow.Intraocular pressure is more than 21 mm Hg or less than 21 mm Hg in drugs.No surgery contraindications.No other eye diseases.The lowest corrected visual acuity is HM/50 cm and the best is 0.4.All the patients were given phacoemulsification associated with goniosynechialysis by the same doctor and same machine,Part of patients need to be given coreoplasty whose pupil diameter is more than 5mm.The intraocular pressure at preoperative and postoperative 1 day,1 week,1 month and 3 months,6 months were observed,visual acuity and the central chamber thicknessat postoperative 1 month and complications were also observed.Results: The difference is significant between preoperative and postoperative after a month(Z=-5.43,P<0.05).The preoperative intraocular pressure was(23.3 ± 4.1)mm Hg,which at postoperative 1 day,1 week,1 month,3 months and 6 months were(17.2 ±4.6)mm Hg,(17.9 ± 2.1)mm Hg,(16.8±1.4)mm Hg and(15.7±1.8)mm Hg and(15.8±1.5),there were statistical differences compared with pre-operation(all P < 0.05),with statistical significance.There is only one case with hyphema and two cases with corneal edema.All improved after symptomatic treatment.The follow-up time were 6 months withnot serious complications.And IOP of them were all within normal range.Scope of corner adhesion were significantly reduced by gonioscope.And compared with the preoperative,the anterior chamber depth were obviously deepened by UBM.The difference is significant(P<0.05).All the visual acuity of 14 eyes has been improved.Conclusion: Investigation of phacoemulsification and intraocular lens implantation combined with Goniosynechialysis operation on intractable angle-closure glaucoma whose IOP can't be controlled after trabeculectomy is obvious.It can significantly control the intraocular pressure,deepen the central chamber thickness and open the range of chamber angles,which is helpful to visual acuity recovery with less complications.It's a new treatment for angle-closure glaucoma whose IOP can't be controlled after trabeculectomy and has value of clinic application.