The Comparative Study Of Phacoemulsification Combined With Goniosynechialysis And Trabeculectomy

Objective : To analyze and compare the effect of phacoemulsification,posterior chamber intraocular lens implantation combined with Goniosynechialysis(Phaco+IOL+GSL)and trabeculectomy(TM)on lowering intraocular pressure in eyes with primary angle closure glaucoma.Methods: A prospective,non-randomized controlled studies was conducted.63 eyes of 63 patients with PACG were recruited in the study from Oct 2016 to Jun 2017 in ophthalmology department of the First Affiliated Hospital of Guangxi Medical University.28 patients were males and 35 were females.According to the degree of lens opacity and visual acuity,these patients were divided into two groups : Phaco+IOL+GSL group with co-exist cataract(visual acuity ? 0.3)and TM group without apparent cataract.Preoperative examinations included: slit lamp,Goldman gonioscopy on dynamic and static condition,direct ophthalmoscopy,non-contact tonometer ocular A/B ultrasound and ultrasound biomicroscopy;Corneal topography,and intraocular lens measurement were done in Phaco+IOL+GSL group.The number of anti-glaucoma medications,best corrected visual acuity(BCVA),intraocular pressure,and postoperative complications,anterior chamber depth(ACD)and the extent of the closed angle were compared.Patients were followed up at 1 week,1 month,3 months and 6 months after surgery,anterior chamber depth measured by ultrasound biomicroscopy,the gonioscopy and ultrasound biomicroscopy were used to determine the extent of the closed angle postoperative 3 months.Results: After surgery,the visual acuity was improved(t=5.016,p=0.000),the mean IOP was reduced(t=5.879,p=0.000),the ACD was deepened(t=-11.143,p=0.00),the closure angle was reopened(t=22.474,p=0.00),the number of anti-glaucoma medications required was decreased(t=6.377,p=0.00)in Phaco+IOL+GSL group.TM group showed stronger effect in reducing IOP,although there was no statistical difference in the number of anti-glaucoma medications between two groups(t=0.760,p=0.450).Conclusion: Phaco+IOL+GSL is safe and effective in the treatment of PACG,it has the potential to improve the visual acuity,reduce the IOP,stop or reduce the use of anti-glaucoma drugs,deepen the ACD,reopen the closure angle and the complications are less.For the treatment of PACG,it is as effective as TM.