| Object: To Contrast to the three surgical treatment of the primary angle-closure glaucoma with Cataract .With a view to provide clinical guidance for PACG with cataract surgery .Method:1 Experimental group: According to the adhesion of the situation of angle was divided into A (angle Adhesion closed≤l80°), B (180° 270°) .In each group were randomly divided into two surgical groups.2 Surgical options: A group of 72 eyes, were randomly divided into two groups, respectively, using phacoemulsification,phacoemulsification with goniosynechialysis. B group of 60 eyes, were randomly divided into two groups, respectively, using Triple procedure,phacoemulsification with goniosynechialysis.3 Preoperative and postoperative follow-up visual acuity, intraocular pressure, slit lamp, fundus, angle, field of vision.Results:1 Vision: 14 of 238 eyes′visual acuity unchanged or decreased. only two eyes of vision had non-raising, no case of decreased after phacoemulsification with goniosynechialysis.2 Intraocular pressure: three groups between the two sub-groups in preoperative IOP was no significant difference.Postoperative:A group: IOP of goniosynechialysis group was significantly lower than phacoemulsification group (P <0.01), intraocular pressure no difference between the different time (P> 0.05).B group: IOP between goniosynechialysis and Triple procedure are differences (P <0.05), there was tension between the different time (P <0.01). One week, the Triple procedure had the lowest IOP.the latter tended to increase; while the IOP of goniosynechialysis was higher than Triple procedure at one week ,followed by a slight decrease, a month after intraocular pressure more stable and less than Triple procedure group (see Fig1), statistically significant difference (P <0.01).C group The mean intraocular pressure of goniosynechialysis group was slightly less than that of Triple procedure group .Difference was not statistically significant (P> 0.05).3 Angle changesAngle was open to varying degrees of 119 eyes after goniosynechialysis at one month, peripheral anterior synechia of iris disappeared. Gonioscopy examination found no adhesions and closed again.Control group, compared with the preoperative anterior chamber angle after part of the wider, flat compared with the preoperative iris root, some patients re-opening angle, peripheral anterior synechia of iris range becomes smaller. But the change was significantly less than separation angle. Follow-up period, the triple therapy group there were four eyes incision anterior synechia of iris.4 visual field47 eyes of goniosynechialysis group with complete data review: The mean postoperative vision light sensitivity (MS)of A group and B group compared with preoperative significantly increased (P <0.01), visual field index MD absolute decrease compared with preoperative, there are differences (P <0.05).MS of C group compared with the preoperative had a downward trend, but no significant difference (P> 0.05). absolute value of visual field index MD compared with the preoperative increase, but the differences were not significant (P> 0.05).Conclusion:1 For PACG with cataract patients with angle closure adhesion≤l80°, only a simple phacoemulsification and intraocular lens implantation can control the IOP. 180° 270°, goniosynechialysis and Triple procedure has no difference in IOP control.2 For the chronic ACG with angle closure adhesion≥270°, IOP control was worse than acute ACG. Although the adhesion of angle after angle are re-opened after Surgery, IOP of 20% chronic ACG had not been controlled effectively.3 The patients who had PACG with cataract raise the degree of postoperative Light sensitivity, dark spots lighter, better vision by early therapy . If the surgical is too late, IOP can be stabilized but the vision may be still deteriorate. |
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