| ObjectiveTo examine the changes of intraocular pressure(IOP),visual acuity,visual function,structural parameters in patients with advanced glaucoma after phaco-trabeculectomy(Phaco-Trab).MethodsA total of twenty-two advanced glaucoma patients diagnosed with chronic primary angle closure glaucoma(CPACG),acute primary angle closure glaucoma(APACG)in the chronic stage or primary open angle glaucoma(POAG)in Tianjin Eye Hospital from June 2019 to January 2020 were included.Twenty-eight eyes were treated with phaco-trabeculectomy.The best corrected visual acuity,IOP and complications of patients in preoperation and postoperative 1 day,1 week,2 weeks,1month,3 months were recorded.We collected visual fied including Humphrey visual field analyzer(HFA)24-2 program(HFA 24-2)and 10-2 program(HFA 10-2)for mean deviation(MD),pattern standard deviation(PSD)at 1 month,3 months after surgery.At last follow-up visit,we collected retinal nerve fiber layer(RNFL)thickness,cup-disc ratio(C/D),ganglion cell complex(GCC)thickness by optical coherence tomography(OCT).We compared changes of those parameters between pre-and post-operation.Change in MD(ΔMD)was defined as the difference of MD at 3 months after surgery from baseline MD.IOP fluctuation value is the standard deviation of intraocular pressure during follow-up.ResultsThe IOP at baseline,1 day,1 week,2 weeks,1 month,3 months postoperatively was 24.61±7.38 mm Hg,18.61±7.05 mm Hg,18.25±6.08 mm Hg,17.10±5.50 mm Hg,15.30±4.00 mm Hg,14.6±3.78 mm Hg,respectively.And the IOP in 1 week,2 weeks,1month,3 months after surgery was significantly reduced from preoperative IOP(all P<0.05).The best corrected visual acuity of the patients before surgery and 1 day,1week,2 weeks,1 month and 3 months after surgery,was 0.41±0.23,0.25±0.2,0.38±0.22,0.42±0.29,0.51±0.27,0.63±0.28,respectively.Compared with preoperative visual acuity,the visual acuity at 1 day was reduced(P=0.001),and the visual acuity at 3 months was improved(P<0.001).The values of HFA 24-2 MD,HFA 24-2 PSD,HFA 10-2 MD,HFA 10-2 PSD before surgery respectively were-24.21±5.44 d B,7.85±3.26 d B,-21.11±8.86 d B,8.68±3.86 d B.There was no significant difference in HFA 24-2 MD,HFA 24-2 PSD and HFA 10-2 PSD between 1 month,3 months after surgery and those before surgery.But the HFA 10-2 MD at 3 months after Phaco-Trab was-19.21±9.42 d B,which was significantly increased compared with HFA 10-2 MD at baseline(P=0.005).In multiple linear regression analysis model,preoperative HFA 24-2 MD(b=0.244,P=0.039)and HFA 10-2 MD(b=0.755,P<0.001)have significantly favorable effect on postoperative HFA 10-2 MD at 3 months after surgery,but the preoperative ocular axial length has significantly negative effect(b=-0.205,P<0.01).The preoperative C/D and ocular axial length were the independent predictors for the HFA 10-2 ΔMD(b=-0.356,P=0.003;b=-0.509,P=0.001).Preoperative HFA 24-2 MD was positive correlation with HFA 24-2 MD at 3 months after surgery(b=0.923,P<0.001).IOP fluctuation was an independently predictor for HFA 24-2 ΔMD(b=-0.493,P=0.008).Compared with preoperative parameters,the thickness of RNFL increased without statistical significance,the C/D decreased significantly(0.88±0.07 VS0.85±0.07,P=0.012),and the thickness of GCC increased significantly at 3 months after surgery(64.89±11.41μm VS 71.43±10.43μm,P<0.001).There were no serious complications occurred.Conclusions1.Phaco-trabeculectomy achieved IOP induction,best corrected visual acuity improvement,vision field improvement in central 10°,and increased ganglion cell complex thickness for advanced glaucoma patients.2.Preoperative MD positively affect postoperative MD at 3months.IOP fluctuation was an independent predictor for HFA 24-2 ΔMD.Ocular axial length negatively correlated with HFA 10-2 MD at 3months.Ocular axial length and preoperative C/D are independent predictors for HFA 10-2 ΔMD.3.For advanced glaucoma patients after phaco-trabeculectomy,we should focus on the change of visual field in central 10° and the thickness of GCC. |
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