The Influence Of The Triple Procedure On Optic Nerve

ObjectGlaucoma and cataract are the most diseases caused blind. Some methods treat glaucoma and cataract, but the best is not sure. Different level patitents were operated with different odus operandis. Vision,IOP,field of vision and hemodynamics of eyeball were measured to evaluate viaual function..we research whether Trabeculectomy combine phacoemulsification and intraocular lens implantation influence on optic nerve.MethodsSelecting 129 patients (129 eyes) suffering glaucoma and cataract in the first hospital of Hebei medical university from december 2005 to july 2007. The patients were divided into four experiment groups. 76 patients (76 eyes) with goniosynechia1/4-1/2, and IOP controled in 17.36mmHg were random distributed into A group and B group. A group were cured to phacoemulsification and intraocular lens implantation, and B group to a triple procedure (phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy).40 patients (40 eyes) with goniosynechia >1/2 were arranged in C group treated with a triple procedure. 33 patients (33 eyes) in D group were treated with phacoemulsification and intraocular lens implantation after trabeculectomy.Each groups were managed with statistical treatment in age and sex, and discrepancy was nonsignificant (P>0.05).All patients vital sign were stable,blood pressure and blood glucose were controled,and absence of complication.Each groups were measured blood flow index (ophthalmic artery, arteria centralis retinae , short posterior ciliary arteries , central retinal vein )with Color Doppler Flow Imaging before three-days. record visual acuity,IOP,ACD,C/D, angle of anterior chamber , measure field of vision. After one week,one month,three month, visual acuity,blood flow index,IOP were measured. After one month and three months angle of anterior chamber,IOP,ACD,C/D and field of vision were recorded.ResultsIOP were lower after operation in all groups. The numerus of A group was smaller than B group obviously. The difference is statistical significance.ACD was deeper after operation in all groups. The numerus of A group was smaller than B group obviously.Angle of anterior chamber were width after operation in all groups. Angle of anterior chamber was open entirly in 4 eyes in A group,and in 7 eyes in B group. angle of anterior chamber was open 90°in 27 eyes in A group, and in 29 eyes in B group. Angle of anterior chamber was open 90°-180°in 7 eyes in A group,and in 2 eyes in B group. The difference is statistical significance. Field of vision was not change obviously. Operation for glaucoma can preserve visual function.Blood flow index (ophthalmic artery, arteria centralis retinae , short posterior ciliary arteries , central retinal vein ) were measured with Color Doppler Flow Imaging. The blood flow rate were quicker after one week,one month,three months.RI were lower. The alteration of B group was more obvious than A group. The blood flow rate of C group was developed obviously.The complication after operation was corneal endothelium oedema, Descemet's membrane wrinkle, shallow of anterior chamber. The example was more in B and C group than A and D group. The complication was disappear after treatment.ConclusionA triple procedure (phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy) is utility to glaucoma and cataract. It can raise vision,control IOP,increase the blood supply of optical nerve,protect field of vision,so can protect visual function efficiently.