The Clinical Efficacy Of Phacoemulsification In Angle-closure Glaucoma And Co-existing Cataract

Objective: It has been reported that glaucoma is one of the main causesof irreversible blindness worldwide by World Health Organization. Thedisease was divided into open-angle glaucoma and angle-closure glaucomaaccording to the angle state. In our country, the angle-closure glaucoma wasmainly composed. The main feature of angle-closure glaucoma is theincreased intraocular pressure because of the angle closure. Such patientsoften accompanied with anatomical characteristics of shallow anteriorchamber, narrow angle, large lens. The lens plays an important role in thepathogenesis of angle-closure glaucoma. Lens extraction could deepen anteriorchamber depth, reduce intraocular pressure. In this study we aimed to comparethe clinical effects of the angle-closure glaucoma co-existing cataract withdifferent extent of goniosynechia after phacoemulsification, providing a widerrange of clinical reference for phacoemulsification as the treatment ofangle-closure glaucoma.Methods: This study included53cases of56eyes with angle-closureglaucoma co-existing cataract which was treated in our hospital from February2011to February2013. There were20male patients (20eyes) and33femalepatients (36eyes). Mean age (±SD) was67.04±6.22years (range from54to78). Inclusion criteria: visual acuity less than0.6, lens opacity, different extentof goniosynechia. Exclude the open angle glaucoma, the neovascularglaucoma, and the history of previous anti-glaucoma or other eye surgerycases. The cases were divided into3groups according to their extent ofgoniosynechia, group A included those with less than180degrees ofgoniosynechia, composed of18cases; group B between180and270degrees ofgoniosynechia, composed of17cases; group C included those more than270degrees of goniosynechia, composed of21cases. All cases performed the phacoemulsification and intraocular lens implantation. Observing the changesof visual acuity, intraocular pressure, the degree of goniosynechia, the anteriorchamber depth and the angle open distance before and after operation. Thechange of visual acuity before and after surgery was determined by Wilcoxontest. The relationship of intraocular pressure between different groups anddifferent times was determined by ANOVA for repeated measurement, theintraocular pressure at different time changes were determined by one-wayANOVA analysis. The analysis of UBM results were determined paired t testin groups and one-way ANOVA between the groups. The composition ratio ofthe degree of goniosynechia was determined by Chi-squared test. A P valuecut-off0.05was considered significant.Results:1Visual acuity: Visual acuity before operation between groups has nostatistical difference (X~2=5.75, P>0.05). The postoperative visual acuity of3groups has improved. The difference is significant (Z=-3.74,-3.53,-4.07,P<0.05). The postoperative visual acuity has no statistical difference (X~2=5.63,P>0.05).2Intraocular pressure: The intraocular pressure change of this experimenthas time×group interaction (F=5.93, P<0.05). The intraocular pressureamong various groups has the difference (F=222.30, P<0.05). The intraocularpressure between the different times has the difference (F=14.75, P<0.05).Each group’s different time intraocular pressure difference has statisticssignificance (F=29.16,34.90,21.48, P<0.05). The results of time groupscomparison indicated that there were differences between preoperative andpostoperative intraocular pressure. There is no difference about the change ofintraocular pressure after operation. In this study, there remained have3patients with higher intraocular pressures than normal, and needed to maintainthe intraocular pressure with anti-glaucoma medicines.3Anterior chamber depth：The postoperative anterior chamber depth of3groups has increased. The difference between pre and postoperative anteriorchamber depth is significant (t=-209.64,-83.30,-56.09, P<0.05). The compare of preoperative anterior chamber depth between the3groups showed nostatistical difference (F=1.81, P>0.05). The compare of postoperative anteriorchamber depth between the3groups showed no statistical difference (F=2.81,P>0.05).4Angle open distance: The postoperative angle open distance of3groupshas increased. The difference between pre and postoperative angle opendistance is significant (t=-14.63,-20.58,-51.09, P<0.05). The preoperativeangle open distance between the3groups has no statistical difference (F=2.75,P>0.05). The postoperative anterior chamber depth between the3groups isdifferent, the difference is significant (F=15.14, P<0.05). There is no differentbetween A and B, but has the different with C.5The degree of goniosynechia: The result showed that the degree ofgoniosynechia less than270about all patients6months after operation, andthe number of less than180degrees is48. The difference of composition ratiobetween pre and postoperative is significant (X~2=21.04, P<0.05).Conclusion: The patient’s visual acuity been improved, the anteriorchamber depth and angle open distance increased, and the closed anglereopened after phacoemulsification. The averaging intraocular pressure ofthree group patients is below21mmHg during the follow-up period, and thechange of postoperative intraocular pressure is steady. The patients ofgoniosynechia less than270degrees taking the phacoemulsification alonecould get a better clinical effect. But the patients of greater270degrees needan attention to the following up, in order to avoid the higher intraocularpressure. The treat of Phacoemulsification for the angle closure glaucoma andco-existing cataract is safe and effective.