| Objective: The purpose of this study was to analyze and explore the clinical efficacy of phacoemulsification combined with goniosynechialysis(Phaco-GSL)for acute primary angle-closure glaucoma(APACG),and to analyze the related factors affecting the postoperative effect.Methods: 56 cases(56 eyes)of acute primary angle-closure glaucoma patients from January 2016 to August 2017 in our hospital were collected for the study,including male patients in 12 cases of 12 eyes,female patients in 44 cases of 44 eyes.According to the patient's intraocular pressure(IOP)and general condition,we choose appropriate drugs to reduce IOP.Based on the IOP of one day before the surgery,patients were divided into 2 groups: A group(normal IOP whose IOP is 10 ~21mmHg)and B group(high IOP whose IOP is 23~35mmHg).There are 41 cases(41 eyes)in the A group,the mean IOP was 15.02±3.52 mmHg.There are 15 cases(15 eyes)in the B group,the mean IOP was 27.93±2.89 mmHg.All patients in the study were treated with Phaco-GSL after full using of drugs to control the IOP.The follow-up time was 6~12 months.Preoperative and postoperative IOP,best-corrected visual acuity(BCVA),pupil diameter(PD),anterior chamber depth(ACD),number of medications(Meds),postoperative complications and other related indicators were observed.The success rates of IOP-lowering effect,the increase rates of BCVA and Meds were compared and analyzed.The IOP and Meds of 6 months after operation was used as evaluation criterions,and divided into complete success,conditional success and failure.Results: 1.In this study,52 eyes(92.86%)were completely successful in 52 cases,4 eyes(7.14%)were conditional successful in 4 cases,and there were no patients with failed operation.The complete success in group A was 39 cases in 39 eyes(95.12%),the conditional success in 2 case was 2 cases(4.88%)in group A;the conditional success was 13 cases in 13 eyes(86.67%)in group B,and the other 2 cases in 2 cases(13.33%).The success rate of the two groups were compared,the difference was not statistically significant.2.The mean BCVA of group A was 0.43 ± 0.21 on one day before operation,and the mean of BCVA was 0.76 ± 0.26 on the 6th month after operation.The mean BCVA of group B was 0.24 ± 0.13 on day before operation,and the mean of BCVA was 0.49 ± 0.24 on the 6th month after operation.BCVA before and after the operative of the two groups were increased,the differences were statistically significant(P<0.05).The BCVA in group A increased by 30 eyes(73.17%)and unchanged in 11 eyes(26.83%)in group A after operation.The BCVA increased by 13 eyes(86.67%)and unchanged in 2 eyes(13.33%)in group B after operation.There was no significant difference between the two groups in the rate of postoperative BCVA improvement.3.In group A,the average PD was 2.93 ± 0.85 mm at 1 day before operation and the average PD was 3.12 ± 0.71 mm at 6 months after operation.In group B,the average PD was 5.40 ± 0.99 mm at 1 day before operation and the average PD was 5.67 ± 0.82 mm at 6 months after operation.The difference between the preoperative and the postoperative PD of the two groups was not statistically significant respectively.4.The analysis of the influencing factors of postoperative IOP showed that there was a linear regression relationship between the preoperative IOP,PD,ACD and the postoperative IOP at 6 months after operation(P<0.05).The preoperative IOP and PD were positively correlated with IOP at 6 months after operation,and the preoperative ACD was negatively correlated with IOP at 6 months after operation.5.The analysis of the influencing factors of postoperative BCVA showed that there was a linear regression relationship between preoperative IOP,postoperative PD and the postoperative BCVA(P<0.05).The preoperative IOP and postoperative PD were negatively correlated with BCVA at 6 months after operation.6.The Meds of two groups after surgery was reduced than that before surgery,the difference between the two groups were statistically significant(P<0.05),no significant difference between the two groups.7.There was a negative correlation between the change of IOP and the change of ACD in all patients(r =-0.296,P <0.05).There was no correlation between IOP and axial length of all patients(r = 0.106,P = 0.436).Conclusion: 1.Phaco-GSL surgery in the treatment of APACG can achieve good effect,IOP at the same time to a certain extent,improve visual acuity,but should be based on the full reduction of IOP on the basis of strict surgical indication.2.In the IOP reduction treatment conditions,the higher the preoperative IOP,the greater the PD,the more shallow anterior chamber,postoperative IOP is relatively higher.3.In the IOP reduction treatment conditions,the higher preoperative IOP,the greater postoperative PD,the worse the postoperative BCVA;the same time,the size of postoperative PD can be predicted on the preoperative PD after the full use of the miotic.4.IOP drop index can be used as a predictive reference for the postoperative IOP and the change of IOP after surgery. |
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