The Change Of Anterior Chamber Angle With Extensive Synechial On Acute Angle Closure Glaucoma And Cataract After Surgery

BackgroundGlaucoma and cataract are common eye diseases in the elderly,and the prevalence rate increases significantly with the increase of age.Both of them are the main causes of blindness.Early diagnosis and systematic long-term treatment can reduce the blindness rate of glaucoma patients,so the treatment of glaucoma has been the focus of attention.To study the early changes of anterior chamber angle?ACA?measurements determined by anterior-segment optical coherence tomography?AS-OCT?in acute angle-closure glaucoma?AACG?and cataract patients with phacoemulsification,intraocular lens implantation with goniosynechialysis?PEI+GSL?and further evaluate the clinical efficacy.ObjectiveTo assess the ACA change and clinical efficacy of PEI+GSL for acute angle closure glaucoma and cataract with extensive angle closure synechiae.MethodThis is a retrospective and prospective study.We studied 35 eyes of 32 patients with AACG and cataract in the First Affiliated Hospital of Xinxiang Medical College from January 2018 to June 2019.The extent of ACA closure synechiae was defined as an eye with?180-degree after comprehensive medication therapy.All patients underwent PEI+GSL and completed an ophthalmologic examination including vision,intraocular pressure?IOP?,angle closure range,anterior chamber depth?ACD?,angle-opening distance at 500mm?AOD500?,trabecular-iris space area at 500mm?TISA500?,trabecular-iris angle at 500mm(TIA₅₀₀)before and 1-day,1-week,1-month and 3 months after cataract surgery and recorded complications then undered statistical analysis.Results1.IOP:Compared with preoperative IOP?42.54±8.06mmHg?,the postoperative IOP of 1 day?16.31±3.60 mmHg?,1 week?15.89±2.67 mmHg?,1 month?15.77±2.63 mmHg?,3months?14.63±3.59mmHg?were significantly decrease?P=0.000?,there was no statistics difference in postoperative comparisons and IOP remained stable on 1 day after surgery.2.BCVA:Compared with preoperative BCVA?0.914±0.290?,the postoperative BCVA of 1 day?0.606±0.255?,1 week?0.406±0.185?,1 month?0.383±0.194?,3months?0.334±0.154?were significantly increased?P=0.000?.Compared with postoperative BCVA of 1 day,postoperative of 1 week?0.40±0.20?,1 month?0.42±0.22?,3months?0.46±0.19?had statistical significance?R=0.039,R=0.040,R=0.002?,but the rest period had no statistical significance?R>0.05?and BCVA remained stable on 1 week after surgery.3.ACD:Compared with preoperative ACD?1.628±0.177mm?,the postoperative ACD of 1 day?3.191±0.177mm?,1 week?3.188±0.220mm?,1 month?3.191±0.219mm?,3months?3.203±0.214mm?were significantly increased?P=0.000?.there was no statistics difference in postoperative comparisons and ACD remained stable on 1 day after surgery.4.Angle parameter:Compared with preoperative of the angle closure range?215.29±30.66?,the postoperative value of 3 months?72.32±28.33?were significantly increased and had statistics significance?P=0.000?.The preoperative AOD₅₀₀ in the temporal and nasal quadrants?0.315±0.015mm,0.308±0.014mm?significantly increased compared preoperative?0.123±0.046mm,0.119±0.039mm?and had statistics significance?P=0.000?.The preoperative TISA₅₀₀ in the temporal and nasal quadrants?0.139±0.018mm²,0.134±0.013mm²?significantly increased compared preoperative?0.032±0.010mm²?,?0.029±0.009mm²?and had statistics significance?P=0.000?.The preoperative TISA₅₀₀ in the nasal and temporal quadrants?36.021±3.230?,?34.420±5.387?significantly increased compared preoperative?12.791±1.990°?,?12.386±2.203?and had statistics significance?P=0.000?.There was no statistics difference in postoperative comparisons and angle parameter remained stable on 1 day after surgery.5.Correlation analysis:There was a negative relative between?IOP and?AOD₅₀₀,?TISA500,?TIA500 in the nasal and temporal quadrants at 3 months after surgery?R=-0.431,P=0.031,R=-0.491,P=0.037,R=-0.387,P=0.028,R=-0.392,P=0.024,R=-0.404,P=0.030,R=-0.501,P=0.022?.There was no correlation between?ACD and?AOD₅₀₀,?TISA₅₀₀,?TIA500 in the nasal and temporal at 3 months after surgery?P>0.05?.Conclusion1.PEI+GSL can effectively open the ACA,deepen the anterior chamber,and improve the visual quality of the patients with AACG and cataract.Through the improvement of angle structure,the effect of reducing IOP can be achieved even if the angle structure is under extensive syenecial,so as to alleviate the attack of AACG.2.There was a negative relative between?IOP and?AOD₅₀₀,?TISA₅₀₀,?TIA₅₀₀,which proves that the decrease of IOP is related to the opening of the angle structure,and further proves the validity of PEI+GSL.