The Efficacy Of ALPI Combined With LPI Andtrabeculectomy In Acute PACG Observation Study

Objective: To investigate the effects of Laser Peripheral Iridoplasty（ALPI）combined with laser percutaneous iridectomy（LPI）and traditional trabeculectomy on primary acute angle closure glaucoma（PACG）.Significance is to compare ALPI with LPI and trabeculectomy for the clinical treatment of acute PACG to seek an effective,safe and minimally invasive treatment.Methods: Sixty patients with acute PACG episodes treated by ophthalmology in Yan’an University Hospital from September 2014 to September 2016 were randomly selected.They were randomly divided into two groups: 30 eyes in each group,group Aperformed ALPI combined with LPI,group B performed trabeculectomy,and the operation was performed by the same surgeon.The standard visual acuity chart was used to detect and record the visual acuity before and after surgery for 1 week and 3 months.The non-contact tonometer（NCT）was used to measuredtheintraocular pressure（IOP）before and after surgery for 1 week and 3 months;Preoperative and postoperative 3 months were measured and recorded anterior chamber depth（ACD）,open distance 500 corner(AOD₅₀₀);TEC-3 visual field was used to detect and record the visual field before and after surgery.HRT-3 confocal microscopy was used to measure and record the preoperative and postoperative 3 months cup / disc ratio（C / D）,disk along the area,optic retinal never fiber layer（RNFL）.The visual acuity analysis of group A and group B was performed by SPSS20.0 statistical software,and the visual acuity analysis of group A and group B was performed.In group A,group B before and after 3 months of ACD,AOD₅₀₀ matching T test;For A,B two groups between ACD and independent sample t-test AOD₅₀₀;C/D,disk along the area,the value of RNFL χ 2 test.result: 1.intraocular pressure（1）A group before surgery,1w after surgery,3m after surgery to complete the visual test results are as follows: preoperative visual acuity（15.44 ± 2.28）mm Hg,1 week after visionacuity（14.13 ± 2.96）mm Hg,3 months after visual acuity（15.50 ± 3.50）mm Hg,P = 0.00,the difference was statistically significant.（2）A group before surgery,1w after surgery,3m after surgery to complete the visual test results are as follows: preoperative visual acuity（15.00 ± 2.78）mm Hg,1 week after visionacuity（14.50 ± 7.01）mm Hg,3 months after visual acuity（14.81 ± 4.07）mm Hg,P = 0.00,the difference was statistically significant.（3）The difference of IOP acuity between group A and group B was P = 0.33,the difference was not statistically significant.2.Vision（1）.A group before surgery,1w after surgery,3m after surgery to complete the visual test results are as follows:preoperative visual acuity（0.37 ± 0.30）,1 week after visionacuity（0.57 ± 0.26）,3 months after visual acuity（0.57 ± 0.25）,P = 0.00,the difference was statistically significant.（2）.B group before surgery,1w after surgery,3m after surgery to complete the visual test results are as follows: preoperative visual acuity（0.36 ± 0.24）,1 week postoperative visual acuity（0.46 ± 0.24）,3 months postoperative visual acuity（0.45 ± 0.23）,P = 0.00,the difference was statistically significant.（3）The difference of visual acuity between group A and group B was P = 0.33,the difference was not statistically significant.3.UBM measured anterior chamber related parameters 3.1 ACD（1）A group of preoperative and postoperative 3 months ACD test results are as follows: preoperative microns（1733.67 ±306.56）,postoperative 3 months（1835.33 ± 249.59）,P = 0.01,the difference was statistically significant.（2）the preoperative and postoperative 3 months ACD group B test results are as follows: preoperative microns（1758.33 ± 134.42）,postoperative 3 months（1841.00±144.35）,P = 0.00,the difference was statistically significant.（3）A and B compared between two groups of postoperative ACD(P = 0.54,there was no statistically significant difference.3.2 AOD₅₀₀（1）A group of preoperative and postoperative 3 months AOD₅₀₀ test results are as follows: preoperative AOD₅₀₀（nose）（98.57±75.89）,postoperative AOD₅₀₀（nose）（227.70±114.20）,P = 0.00,the difference was statistically significant;Preoperative AOD₅₀₀（next）（60.00±53.38）,postoperative AOD₅₀₀（next）（203.27±118.45）,P = 0.00,the difference was statistically significant;Preoperative AOD₅₀₀（temporal）（85.27±80.13）,postoperative AOD₅₀₀（temporal）（226.27±117.40）,P = 0.00,the difference was statistically significant;Preoperative AOD₅₀₀（on）（44.27± 60.32）,postoperative AOD₅₀₀（on）（117.67±89.85）,P = 0.00,the difference was statistically significant.（2）the B group of preoperative and postoperative 3 months AOD₅₀₀ test results are as follows: preoperative AOD₅₀₀（nose）（101.07±73.88）,postoperative AOD₅₀₀（nose）（208.97±104.94）,P = 0.00,the difference was statistically significant;Preoperative AOD₅₀₀（next）（57.60±53.49）,postoperative AOD₅₀₀（next）4.Field of view The rate of visual field in group A was 0.0%,and the rate of visual field in group B was 3.3%.The difference between the two visual field was P = 0.50,the difference was not statistically significant.5.C/D The rate of C / D in group A was 0.0%,and the rate of C / D in group B was 3.3%.The difference between the two C/D was P = 0.50,the difference was not statistically significant.6.Disk area along the boardThe rate of disk area along the area of group A was 3.3%,and the rate of disk area along the area ofgroup B was 3.3%.The difference between the two Disk area along the boardwas P = 0.50,the difference was not statistically significant.7.Retinal nerve fiber layerThe rate of RNFL in group A was 3.3%,and the rate of RNFL in group B was 3.3%.The difference between the two RNFLwas P = 0.50,the difference was notstatistically significant.Conclusion: Two kinds of treatment of primary acute angle-closure glaucoma in patients with 3 months of short or medium-term effect is as follows:1.ALPI combined with LPI and traditionaltrabeculectomy,IOP after surgery were lower than before surgery,visual acuityafter surgery were better than before surgery,but no significant difference between the two;2.ALPI combined LPI and traditional anterior chamber after trabeculectomy surgery ACD,AOD₅₀₀ increase than before the operation,but no obvious difference between;3.There was no significant difference between ALPI combined with LPI and the conventional trabeculectomy in the control of the 3 months field of vision,C/D value,the decrease of the area of the disc and the control of the decrease of RNFL.