| Purpose:To observe the safety and efficacy of goniosynechialysis and phacoemulsification and intraocular lens implantation(GSL+Phaco+IOL)in the treatment of acute angle-closure glaucoma(AACG).Method:290 cases538 eyes of AACG patients from July 2016 to January 2018 at the Second Affiliated Hospital of Nanchang University were collected,and the case data were divided into 3 groups: Group A(acute attack phase): 313 eyes;Group B(preclinical phase of GSL+Phaco+IOL): 140 eyes;Group C(preclinical phase without any treatment):90 eyes.The 5 patients with acute attack of the untreated group were transferred to group A after operation.The changes of the visual acuity,intraocular pressure,high intraocular pressure,complication,optic nerve and visual field of the 3rd day,second weeks,3rd m,6th months,9th months,12 th months,18 th months were observed before and after operation between Group A and Group B as well as Group B and Group C.RESULT:1.The intraocular pressure(IOP):IOP:In group A:the pre-operative IOP:(37.94±19.24)mm Hg,,the postoperative IOP of the 18 th months:(13.75±2.01)mm Hg,the IOP in each time period compared with that in pre-operation had a significant decrease and statistic difference(P<0.001).In group B,the pre-operative IOP:(15.85±4.58)mm Hg,,the postoperative IOP of the18 th months:(14.17±2.64)mm Hg,the postoperative IOP decreased and there were statistic differences in 3 days,2 weeks,3 months after operation(P<0.05),In group C:during observation period,5 eyes were observed with the occurrences of acute angle-closure glaucoma.Between groups: The preoperative IOP of group A > that of group B and had statistic difference(P<0.001).while there was no statistic difference in postoperative comparisons(P>0.05).In the comparison between group B and group C,with the prolonging of time,the IOP of the group C has been higher than that of group B;the P values before operation and after operation of 3 days were all >0.05 and had no statistic differences while the P values were <0.05 and had statistic differences in other time periods.2.The highly postoperative IOP: Group A: 43 cases of high IOP(>21mm Hg)were observed in total.With the absorption of viscoelastic,the high IOP gradually decreased.At last,2 cases were re-received an operation,and 25 cases received drug therapy.Among them,288 cases that did not use drugs dropped to normal(≤21 mm Hg)accounted for 92.01%,and 22 cases that used drugs dropped to normal accounted for 7.03%.Group B:7 cases suffering high IOP were observed in total,.After the finding of high IOP,zero case was re-received operation,and 5 cases used drug therapy.Among them,133 cases without medication control accounted for95.00%,and 7 cases with medications dropped to normal accounted for 5.00%.Group C(for preoperative and postoperative acute severe onset of the fellow eyes): total of12 cases of high IOP were found.5 cases of being found with high IOP(acute severe onset)were received operation,and 7 cases applied with drug therapy.Among them,78 cases without medication control accounted for 86.67%,7 cases with medication control accounted for 5.00%.3.The corrected visual acuity(BCVA):the pre-operative BVCA:3.34±1.22,the postoperative BVCA of the 18 th months:4.58±0.27.Compared with preoperative vision,the postoperative BCVA of group A was significantly increased and had a statistic difference(P<0.001).For group B:the pre-operative BVCA:4.47±0.51,the postoperative BVCA of the 18 th months:4.73±0.18.the postoperative vision slightly increased compared with the preoperative vision,but there was no statistic difference(P>0.05);after 2 weeks after the operation,the vision constantly increased and had a statistic difference(P<0.05).There was no statistic difference observed in group C during the same time period within follow ups(P>0.05).The BCVA of group A within 3 days,2 weeks after the operation was lower than group B within respectively,and there was a statistic difference between group A and group B(P<0.05).For the comparison between group B and group C,there was no significant statistic difference,however,the BCVA of group C was lower than that of group B with the time prolonged(P>0.05).4.The depth of the central anterior chamber:Before operation: the anterior chamber depth(ACD)of group A was(1.65±0.29)mm,and the ACD of group A was(1.87±0.34)mm.Postoperative ACD: of group A was(3.53±0.45)mm and of group B was(3.50±0.46)mm.The preoperative ACD of group A was larger than that of group B,and there was a significant statistic difference(P<0.001).Postoperative comparison between group A and group B,there was no significant statistic difference(P>0.05).The postoperative ACD of both these groups were increased in comparison with preoperative ACD,and there was a statistic difference(P<0.001)in this comparison.5.Periocular optic nerve fiber layer(RNFL)thickness:Comparison in one group: In group A,RNFL thickness decreased in each quadrant during follow-up compared with the preoperative periocular RNFL thickness.With repeated variance analysis(ANOVA),it was found that with time changing,the trends of superior and inferior of group A and group B had significant differences(P<0.001).The periocular RNFL thickness of group A in each quadrant showed a trend of decreasing with the change of time,and was lower than that of group B.In group B,RNFL thickness increased in each quadrant during follow-up compared with the preoperative periocular RNFL thickness,however,compared with preoperative,only the superior in the 6th month and the temporal in the 12 th month had statistic differences(P<0.05).In group C,there was no obvious difference in RNFL thickness in each quadrant during follow-up after the operation for the acute onset of fellow eyes(P>0.05).Group B and group C generally kept stable during follow ups.6.The vision Field(d B):Intra-group: PSD and MD absolute values among groups: group A > group B.postoperative PSD of three groups in each time period kept stable compared with preoperative PSD and all had no statistic difference(P>0.05).MD: compared with preoperative,the absolute value of group A had a certain drop,and there were statistic differences in 3 months and 6 months after operation(P<0.05).The absolute value of group B compared with preoperative,there was no statistic difference(P>0.05)during follow ups.There was no statistic difference(P=0.28,1.00,1.00)betweengroup B and group C.7.Postoperative complications: In group A,5 cases of posterior lens capsule rupture occurred during operation,among which 2 cases were implanted with suspensory intraocular lens(IOL),1 case was not implanted with lens,and 2 cases were implanted with IOL into ciliary sulcus.The inflammation happen in both group A and group B was mild,and 49 cases of corneal endothelial edema developed(the pre-operative cases were 26),and 13 cases of anterior chamber inflammation was found both of them were improved by conservative treatment.There were 7 cases of postoperative posterior cataract(1.55%).Conclusion:1.GSL+Phaco+IOL can relieve the incidence of the angle-closure glaucoma from nosogenesis effectively.2.GSL+Phaco+IOL can improve or maintain stability of acute attack eye vision.Intraocular pressure,optic nerve,visual field function is relatively stable,but can not prevent the optic nerve ischemia and reperfusion injury and other secondary changes.3.For clinical patients in the early stage,GSL+Phaco+IOL can effectively prevent the acute attack of angle-closure glaucoma,improve or maintain eyesight,and maintain the optic nerve and visual field function relatively stable and even improve.4.Intraoperative and postoperative complications were relatively few,the reoperation rate was low,and the disturbance of visual function was relatively safe. |
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