Clinical Study On The Management Of Primary Angle-closure Glaucoma By Phacoemulsification With Foldable Posterior Chamber Intraocular Lens Implantation

Objective:To study the clinical results and safety of phacoemulsification with foldable posterior chamber intraocular lens (PC-IOL) implantation in the management of acute or chronic primary angle-closure glaucoma(APACG or CPACG) with cataract.Patients and methods:1.Research methods: Through tunnel incision phacoemulsification and posterior intraocular lens implantation (Phaco+IOL) in eye with simple cataract. Through corneal incision phacoemulsification and intraocular lens implantation in eye with primary angle-closure glaucoma.Preoperative and postoperative visual acuity,intraocular pressure(IOP),the rate of open-angle,depth of anterior chamber(ACD),total length of the eye(TL),antiglaucoma medications and complications were observed. Postoperative time of following up was 3～24 months, average(8.5±4.5) months.2.Cases: Research group: Prospective clinical trial and consecutive case series. 26 cases(28 eyes) with simple cataract, 60 cases(70 eyes) primary angle-closure glaucoma with cataract ,including 29 eyes with acute primary angle-closure glaucoma, 27 eyes with chronic primary angle-closure glaucoma were randomly choosed from January 2005 to December 2006. visual acuity distribute from hand movement to 0.8,age from 50 to 80,without other eye diseases or ocular surgery. Comparison group: patients of homologous age and visual acuity with simple age related cataract.3.Statistic analysis: Data was evaluated by SSPS 11.0 statistic software.Results:1.The success probabilities assessed with postoperative IOP level: The total success probability was 95.3%; the partial success probability was 4.7% in the group of APACG .The total success probability was 77.8%; the partial success probability was 14.8%;the failure probability was 7.4% in the group of CPACG .2.IOP and antiglaucoma medication: In simple cataract group (n=56), preoperative IOP was (13.59±4.03)mmHg; postoperative IOP was (12.76±3.73)mmHg(t=1.9201,P>0.05); In preclinical stage of APACG group (n=14), preoperative IOP was (11.77±1.89) mmHg; postoperative IOP was (10.44±1.66)mmHg(t=3.9910,P<0.01);In period of onset of APACG group(n=29),preoperative IOP was (19.78±9.73)mmHg; postoperative IOP was (10.97±2.31)mmHg(t=4.7441,P<0.001); In CPACG group(n=27),preoperative IOP was (19.94±4.14)mmHg; postoperative IOP was (15.07±3.81)mmHg(t=4.4976, P<0.01).Postoperative IOP of APACG was lower than that of CPACG.In APACG group preoperative antiglaucoma medication was (1.08±1.13); postoperative antiglaucoma medication was (0.08±0.28)(t=4.6257, P<0.001); In CPACG group preoperative antiglaucoma medication was (1.36±0.70); postoperative antiglaucoma medication was (0.12±0.41)(t=7.9425, P<0.001).3.The rate of open-angle and the extent of synechiae: In primary acute or chronic angle-closure glaucoma group, angle of anterior chamber was widen, In APACG group,χ2 = 51.3333, P<0.001; In CPACG group,χ2 =34.9091, P<0.001.4.The central and peripheral depth of the anterior chamber: In APACG group, preoperative depth of the anterior chamber (ACD) was (2.07±0.23)mm; postoperative ACD was (3.62±0.36)mm; (t=8.8408,P<0.001). preoperative ACD/ TL was (0.093+0.009)mm; postoperative ACD /TL was (0.159+0.0126)mm(t=8.8408,P<0.001) .In CPACG group, preoperative ACD was (2.36±0.36)mm; postoperative ACD was (4.03±0.46)mm(t=6.632 ,P<0.001). Preoperative ACD/TL was (0.104+0.015), postoperative ACD /TL was (0.179±0.009)(t=5.9432,P<0.001).Preoperative limbic ACD of APACG and CPACG was much less than that of postoperative (APACGχ2=58.0000, P<0.001;CPACGχ2=54.0000, P<0.001).5.Visual acuity: In 56 eyes of PACG, corrected visual acuity of 48 eyes(85.7%) in raised postoperatively; corrected visual acuity of 28 eyes(50%)>0.5. 8 eyes(14.3%) did not raise. Both of acute and chronic primary angle-closure glaucoma group, visual acuity raised Preoperatively(P<0.05).6.Complications: There is no rupture of posterior capsule membrane during the operation, and the postoperative inflammatory reactions was low. The serious postoperative complications ,such as corneal endothelial decompens and retinal detachment were not discovered.Conclusions:That the phacoemulsification with foldable posterior chamber intraocular lens implantation was benefit to IOP, chamber angle, depth of anterior chamber and visual function for primary angle-closure glaucoma with cataract. IOP of simple cataract was not affected, but IOP of preclinical stage of APACG was lowered by phacoemulsification.Moreover, the surgical curative effect of acute angle-closure glaucoma was better than that of chronic angle-closure glaucoma.