Clinical Analysis Of The Management And Visual Quality In Acute Primary Angle Closure Glaucoma Combined With Cataract

Objective:To evaluate and discuss the clinical effect and visual quality of phacoemulsification combined with trabeculectomy and phacoemulsification combined with goniosynechialysis in acute primary angle-closure glaucoma with cataract.Objects and methods:The retrospective analysis research 46 cases of acute primary angle-closure glaucoma with cataract,from January 2017 to January 2018 in the first affiliated hospital of Fu jian Medical University,including 16 males(16 eye),30 women(30eye),were chosen for the study.The 46 patients were pared into two groups by different surgery.23 eyes were done phacoemulsification combined with trabeculectomy(refered to as the trabeculectomy group),other 23 eyes were done phacoemulsification combined with goniosynechialysis(refered to as the goniosynechialysis group).Evalute the two different groups with visual acuity?Intraocular pressure(IOP)?corneal endothelium cout?anterior chamber depth(ACD)?angle opening distance at 500 microm from the scleral spur(AOD500)?trabecular-ciliary process distance(TCPD)and the postoperative complications,the follow-up time was 1 month-12 month.Results:The two groups baseline comparison showed no statistical significance(P>0.05)in the age?gender?visual acuity?Intraocular pressure(IOP)?corneal endothelium cout and UBM related indicators.visual acuity:The comparison of the trabecular group and the goniosynechialysis group between preoperative and postoperative was statistically signficant(P<0.05),two suigical ways could enhance the vision;The comparison of the trabecular group and the goniosynechialysis group between postoperative was not statistically signficant(P>0.05),the vision enhance effect was same.Intraocular pressure:The preoperative and postoperative IOP of the trabecular group was25.9±3.380mmHg and 14.7±1.680 mmHg,the IOP of the goniosynechialysis group was(preoperative)24.3±3.190 mmHg and(postoperative)17.0±1.6 90mmHg,the difference was statistically signficant(P<0.05),the two groups were both good to IOP control,and more the trabecular group to reduce IOP was superior to the goniosynechialysis group.corneal endothelium cout:The preoperative and postoperative cell numbers of the trabecular group was 2203.20±365.40/mm~2 and1830.30±367.60/mm~2,the preoperative and postoperative cell numbers of the goniosynechialysis group was 2130.10±398.90/mm~2 and 1947.30±331.30/mm~2,the difference was statistically signficant(P<0.05),two surgical methods both reduced cell numbers,and the trabecular group to reduce cell numbers was more to the goniosynechialysis group.UBM related indicators:The preoperative and postoperative ACD of the trabecular group was 1.150±0.270mm and 3.080±0.220mm,the preoperative and postoperative ACD of the goniosynechialysis group was1.170±0.280mm and 3.300±0.220mm,the difference was statistically signficant(P<0.05),the two surgical methods both were good to deepen ACD,and the goniosynechialysis group to deepen ACD was superior to the trabecular group;The AOD500 comparison of the preoperative was statistically signficant(P<0.05)to the postoperative;The TCPD comparison of the preoperative and postoperative was statistically signficant(P<0.05);The comparison of postoperative complications between the trabecular group and the goniosynechialysis group was statistically signficant(P<0.05),the trabecular group was more.Conclusion:1.Phacoemulsification combined with trabeculectomy and phacoemulsification combined with goniosynechialysis were safe and effective methods for the treatment of acute primary angle-closure glaucoma with cataract.2.For the visual acuity,there was no difference between the trabecular group and the goniosynechialysis group;For the clinical reduced effect in IOP the goniosynechialysis group was worse to the trabecular group;But in improving the anterior chamber structure(such as ACD,AOD500 and TCPD),the goniosynechialysis group was superior to the trabecular group.3.The trabecular group had more loss rate of corneal endothelium cell and postoperative complications compared the goniosynechialysis group.