An Observation Of Phacoemulsification And Intraocular Lens Implantation Combining With Trabeculectomy For Primary Angle-closure Glaucoma Combing With Thick Lens Of Cataract

Objective: To observe the clinical effect of phacoemulsification and intraocular lens implantation combining with Trabeculectomy for primary angle-closure glaucoma combing with thick lens of cataract.Methods: Prospective study was performed in 67cases(81eyes) of primary angle-closure glaucoma patients with thick lens of cataract from January 2008 to March 2009 in our hospital.The patients were randomly divided into two groups.Group A received phacoemulsification and intraocular lens implantation combining with trabeculectomy.Group B received trabeculectomy. Best corrected visual acuity,intraocular pressure,postoperative complication and anterior chamber angle's related structures with UBM: anterior chamber depth(ACD),angle opening distance at 500 microm from the scleral spur (AOD500),trabecular-iris angle(TIA) and trabecular-ciliary process distance(TCPD) were observed in two groups after operation.Results: The results in the final follow-up after operation were as follows : the best corrected visual acuity in Group A improved significantly(P<0.05),the best corrected visual acuity in Group B did not change significantly(P>0.05).The intraocular pressure in the two Groups decreased significantly(P>0.05),the intraocular pressure in Group A was lower significantly than in Group B (P<0.05).The anterior chamber depth in Group A deepened significantly(P<0.05), the angle opening distance at 500 microm from the scleral spur in Group A enlarged significantly(P<0.05),the trabecular-iris angle in Group A widened significantly(P<0.05),the trabecular-ciliary process distance enlarged significantly(P<0.05).The anterior chamber depth,the angle opening distance at 500 microm from the scleral spur,the trabecular-iris angle,the trabecular-ciliary process distance in Group B did not change significantly(P >0.05).Afteroperation,no shallow anterior chamber or malignant glaucoma was occurred in Group A, 7 shallow anterior chambers (17.95%) and 1 malignant glaucoma (2.56%)were occurred in Group B. Conclusions: 1,The treatment of primary angle-closure glaucoma with thick lens of cataract by phacoemulsification and intraocular lens implantation combining with trabeculectomy is effective.2,Phacoemulsification and intraocular lens implantation combining with trabeculectomy can relieve crystalline lens block and pupil block;it is superior to trabeculectomy on the aspects of deepenning the anterior chamber depth,enlarging the angle opening distance at 500 microm from the scleral spur and the trabecular-ciliary process distance,widing the trabecular-iris angle ,ameliorating circulation of aqueous fluid and reducing intraocular pressure.3,Phacoemulsification and intraocular lens implantation combining with trabeculectomy can improve vision of primary angle-closure glaucoma's patients, obviate reoperative,save money for patiens.4,Phacoemulsification and intraocular lens implantation combining with trabeculectomy can reduce postoperative complications such as shallow anterior chamber or malignant glaucoma.