Clinical Analysis Of Malignant Glaucoma After Primary Angle-closure Glaucoma Filtration Surgery

Purpose：To report the incidence of malignant glaucoma after primaryangle-closure filtration surgery, explores the factors related to the diseaseand treatment effect, in order to guide clinical diagnosis and treatment.Methods： From2006December to2012June,920cases (1050eyes) withprimary angle-closure glaucoma patients received filtration surgery in ourhospital,12cases(12eyes)developed malignant glaucoma after filtrationsurgery.Because the clinical data of2cases (2eyes) in patients lacksomething, so those data only applied to the calculation of incidence ofmalignant glaucoma.And to collect clinical data of8cases (9eyes),which hasbeen diagnosed as malignant glaucoma in another hospital during the sameperiod.(1)920cases (1050eyes) with primary angle-closure glaucoma patientswere divided into acute angle-closure glaucoma (AACG)group and chronicangle-closure glaucoma (CACG) group. According to the AACG and CACG groupfiltration of malignant glaucoma occurred after the number of cases forstatistical analysis.The number of two groups of patients which developedmalignant glaucoma after filtration surgery were analyzed statistically.(2)In18cases (19eyes) gender, age of the patients was analyzed.(3) To analyzethe central anterior chamber depth before surgery and axial length of10cases(10eyes) which developed malignant glaucoma occurred in our hospital.(4)According to the onset of malignant glaucoma,18cases(19eyes) were dividedinto two groups.The malignant glaucoma occur for one week after filtrationsurgery were seted to A group,others were seted to B group.We treat two groupsthree days with drug,respectively recording their intraocular pressurevalues on the third day,and the results were analyzed statistically.(5)18cases (19eyes) were treated with drug3～7days, if their intraocular pressure remains poorly controlled,we use surgical or laser treatment. According totheir different clinical features, we respectively take vitreous suction andanterior chamber reconstruction surgery;lens extraction with intraocular lensimplantation;phaco+IOL+pars plans vitrectomy;cyclopphotocoagulation; Nd:YAG laser treatment.（6）Rule out other factors in18cases(19eyes),such asthe contralateral eye have disease、the contralateral eye is artificialeye,the patient refuse treatment or the contralarteral eye has receivedglaucoma surgery,7cases (7eyes) accepted Nd∶YAG laser in peripheraliridectomy.Results：（1) The incidence of malignant glaucoma after primaryangle-closure filtration surgery was1.143%（12/1050）,the incidence of AACGgroup558cases(654eyes) was0.765%（5/654）,the incidence of CACG group362cases(396eyes) was1.768%(7/396).According to those data in the X2test，therewas no significant difference(X2=2.197，p>0.05),it shows that there were norelation between the incidence of malignant glaucoma and the type of primaryangle-closure glaucoma.(2）gender and age: there were three men and fifteenwomen,the oldest was86years old, the youngest was39years old,the averageage was (63.61±13.23),One case under the age of40(including40),3cases werebetween40and50(including50),2cases were between50and60（including60),12cases were over the age of60.It shows that the malignant glaucoma inpatients with mostly over the age of60.(3)i the central anterior chamber depthbefore surgery: in the10cases (10eyes),the deepest was2.17mm,the mostshallow was1.2mm,the average depth was1.71±0.31mm，8cases (8eyes) werebetween1mm and2mm,2cases (2eyes) were over2mm.It shows that in thisresearch the central anterior chamber depth before surgery of patients withbetween1mm and2mm.ii the axial length:In10case (10eyes),the longest was23.9mm,the shortest was20.04mm, the average length was21.64±1.15mm，7case（7eyes) were between20mm and22mm,3case (3eyes) were over22mm.In ourresearch,the axial length of patients were more between20mm and22mm.(4) In the third days of drug treatment,the average intraocular tension of A was28.27±10.22mmHg, B was49.75±14.91mmHg. Compare the the average intraoculartension of A group with B group use the two independent sample t test, thedifference was statistically significant(t=-3.738，p<0.05)，mean that thesooner malignant glaucoma happen,the more easy to cause with drug.(5) In thisgroup of18cases (19eyes), except for one patient refuse surgery,theintraocular tension of2cases (2eyes) went down to a normal level.15cases(16eyes) all accept surgery or laser treatment,when they left the hosptial,14cases (15eyes) intraocular tension went down to a normal level and theiranterior chamber recovered.There were no serious complications happen.Followup of6months～6years,12cases (13eyes) with good control of intraocularpressure,2cases(2eyes)’s field of vision than discharge progress, but nochange in vision.1cases(1eyes) cataract phacoemulsification and intraocularlens implantation+front of the glass resection, discharge IOP was17mmHg,patients have to go to a higher level hospital treatment after discharge,parallel intraocular lens removal surgery, postoperative choroidal detachment,two times of forming anterior chamber formation of anterior chamber,intraocular pressure control application of drugs. In1cases (1eyes) werefollowed for up to6years, the intraocular pressure control is not ideal,decreased visual acuity to index, vision is temporal islet.(6)All cases werefollowed up for6months to6years after the therapy,7cases (7eyes) whichaccepted Nd∶YAG laser in peripheral iridectomy,6cases (6eyes)contralateral eye were not progress, and were not develop into malignantglaucoma;1cases(1eyes) postoperative half year we can consider for malignantglaucoma elevated intraocular pressure, the suggestion to the superiorhospital make a diagnosis and give treatment,the superior hospital takeSLT,intraocular pressure has not yet reached target intraocular pressure,visual field progress,use2or3kinds of glaucoma medications for him,wecontinue follow up3years,but his vision progressive decline and view progress in tube.Conclusions:(1) The incidence of malignant glaucoma after primaryangle-closure filtration surgery was not relationship with the type ofangle-closure glaucoma.(2）malignant glaucoma after filtration surgery is apathological process that it led by many complex variety of factors,but thereare some link with the age、gender、 central anterior chamber depth beforesurgery and the axial length.(3) The correlation of the effect of drugtreatment with onset time of malignant glaucoma after primary angle-closurefiltration surgery is relevant.（4）The drug treatment can be used earlystage,if intraocular tension of patient can not be control,we should takesurgery or laser on time,in order to avoid deterioration.(5)Nd:YAG laser inperipheral iridectomy can yet be regarded as an effective treatment for thecontralateral eye of malignant glaucoma.