The Changes Of Retinal Nerve Fiber Layer In Acute Angle-closure Glaucoma

Background and purpose:Primary angle-closure glaucoma(PACG)has become the first irreversible blinding eye disease.Due to ethnic characteristics,the most common type of glaucoma in China is PACG,which is harmful to the medical and health services in China.Optic nerve injury is one of the common characteristics and clinical manifestations of glaucoma.This study observed the changes of retinal nerve fiber layer(RNFL)and cribriform plate tissue after acute attack of PACG,so as to provide the basis for intervention,diagnosis and treatment and follow-up of patients with PACG.Materials and methodsAccording to the inclusion and exclusion criteria,30 patients(60 eyes)with first monocular attack of APACG were selected from the Affiliated Hospital of Yan’an University from October 2018 to October 2019.Among them,21 were females and 9were males.,the average age was 52.5 ± 10.7 years old,and the onset time before admission was 51.7 ± 33.2 hours.The contralateral eye was the control group and the paroxysmal eye was the observation group.According to the guidelines for glaucoma surgery in China in 2020,the patients were given corresponding treatment.Intraocular pressure and optical correlation tomography(OCT)were performed before operation,3months,6 months and 12 months after operation.The intraocular pressure,RNFL thickness in all directions around the optic disc,Bruch membrane opening distance,cribriform plate thickness and cribriform plate thickness were recorded.All the data were analyzed statistically.Results: 1.The intraocular pressure after glaucoma surgery was significantly different from that before surgery(P < 0.01).2.There was no significant difference in RNFL thickness,cribriform plate anterior tissue thickness and cribriform plate tissue thickness between the contralateral eyes after preventive iris surgery.The thickness of the contralateral eye was different in all directions,among which the thickest was subtemporal and supratemporal,followed by subnasal and Supranasal,and the thinnest was temporal and nasal.3.The RNFL thickness in all directions of the paroxysmal eye was significantly different from that of the contralateral eye before operation,and the thickness of the paroxysmal eye was larger than that of the contralateral eye.At 3-month follow-up,the RNFL thickness and average thickness in all directions around the optic disc were significantly different from those before operation(P < 0.05).At 6 months follow-up,there were significant differences in Supranasal,infranasal,infratemporal,supratemporal and contralateral eyes(P < 0.05).There was no significant difference in nasal,temporal and mean thickness between the two eyes,but there was a downward trend.At 1-year follow-up,there were significant differences in the average thickness of Supranasal,infranasal,supratemporal,infratemporal,nasal,temporal and contralateral eyes(P <0.01).Compared with the contralateral eye,there was obvious atrophy and thinning.4.Compared with the contralateral eye,the thickness of anterior ethmoid plate in the attack eye was significantly thicker(P < 0.01).With the development of the disease,gradually thinner.At 3 months after operation,the thickness of anterior ethmoid plate was less than that of the contralateral eye,but the difference was not statistically significant(P > 0.05).There was a significant difference in the thickness of the anterior ethmoid plate between 6 months and 1 year after operation(P < 0.05).5.There was no significant difference in the thickness of cribriform plate between the contralateral eye and the paroxysmal eye before operation.At 3 months after operation,the thickness of cribriform plate between the two eyes had no statistical significance,but it had a downward trend at this time.At 6 months and 12 months after operation,the thickness of cribriform plate atrophied and thinned,which had statistical significance compared with the contralateral eye(P < 0.01).Conclusion:1.The RNFL thickness of PACG patients is different in all directions around the optic disc: subtemporal > supratemporal > subnasal > Supranasal >temporal > nasal.2.After preventive surgery,RNFL thickness did not change significantly in patients with PACG.Compared with the contralateral eye,the RNFL thickness of the paroxysmal eye was thicker before operation,which was larger than that of the contralateral eye;at 3months after operation,there was no significant difference between the paroxysmal eye and the contralateral eye;at 6 months after operation,the RNFL thickness of the Supranasal,infranasal,supratemporal and infratemporal eyes was thinner than that of the contralateral eye.Compared with the contralateral eye,the average RNFL thickness,nasal RNFL thickness and temporal RNFL thickness were not significantly thinner,but there was a thinning trend at this time;one year after operation,they were significantly thinner.3.Before PACG,the thickness of the anterior cribriform plate in the attack eyes was significantly thicker than that in the non attack eyes.At 3 months follow-up,there was no significant difference between the two eyes.At 6 months follow-up,the thickness of anterior ethmoid plate and ethmoid plate was thinner than that of contralateral eye,and the difference was statistically significant.