Clinical Observation Of Goniosynechialysis Combined With Phacoemulsification And Intraocular Lens Implantation For Chronic Angle-closure Glaucoma

Purpose:To observe the clinical effect of goniosynechialysis and phacoemulsification and intraocular lens implantation(GSL+Phaco+IOL)in the treatment of chronic angle-closure glaucoma(CACG).Method:A total of 274 patients(382 eyes)with chronic angle-closure glaucoma who were treated with GSL + Phaco + IOL surgery in the Second Affiliated Hospital of Nanchang University from December 2016 to February 2019 were collected.The intraocular pressure,visual acuity,central anterior chamber depth,the number of anti-glaucoma medications,optic nerve fiber layer thickness and visual field changes before surgery,3 days and 2 weeks post-operation,and 3 months,6 months,9 months,12 months and 18 months post-operation were compared.The intraoperative and postoperative complications were recorded and statistically analyzed.RESULT:1.The intraocular pressure(IOP):The mean intraocular pressure was(23.19±9.60)mmHg pre-operation,(16.22±5.11)mmHg 3 days post-operation,and(15.66±3.74)mmHg 18 months post-operation.The mean IOP decreased significantly(P<0.01)and tended to be stable at different time points after surgery.2.The number of anti-glaucoma medications and postoperative high IOP: The average number of anti-glaucoma medications used pre-operation was(2.15±1.23),and the average number of medications used 3 days post-operation was(0.59 ± 1.02),the number of medications used at 18 months of follow-up was(1.03±0.91).The number of anti-glaucoma medications used at each time point after surgery was significantly reduced,with a statistically significant difference from the preoperative ratio(P<0.01).A total of 101 eyes with high intraocular pressure(>21mmHg)were found after surgery,and 291 eyes(76.18%)did not use any drugs dropped to normal(≤21mmHg)after surgery,and 79 eyes(20.68%)that used drugs dropped to normal.Six reoperations for high IOP were found during the postoperative follow-up period.3.The corrected visual acuity(BCVA): The average preoperative visual acuity was(4.17±0.95),the visual acuity was(4.42±2.24)3 days post-operation,and the visual acuity was(4.59±0.42)18 months post-operation,which was significantly higher than that before operation(P<0.05).4.The depth of the central anterior chamber:The preoperative central anterior chamber depth was(1.96±0.27)mm,increased to(3.35±0.53)mm post-operation.The difference was statistically significant(P<0.01).5.Optic nerve fiber layer(RNFL)thickness: The thickness of the peripapillary nerve fiber layer was thicker than that before operation,and there was a statistically significant difference over time during the postoperative follow-up period(P<0.01).6.The vision Field(dB): The PSD was increased at 9m post-operation compared with that pre-operation,without statistical difference(P>0.05).The PSD at other follow-up time points was lower than that before operation,but there was no statistically significant difference(P > 0.05).MD: The absolute value of MD showed a decreasing trend during the follow-up period,with statistical difference(P<0.01).7.Postoperative complications: 2 cases(0.52%)of posterior capsular rupture occurred in all patients during the operation,of which 1 case was not implanted with suspensory intraocular lens,and the another case was implanted with IOL into the ciliary sulcus.Postoperative inflammatory reaction was mild,and mild to moderate corneal edema occurred in 45 cases,which was improved after conservative treatment.Postoperative follow-up revealed 12 cases of posterior cataract.Conclusion:1.GSL+Phaco+IOL can effectively reduce intraocular pressure in patients with chronic angle-closure glaucoma,vision can be improved or stabilized,and optic nerve and visual field function are relatively stable;2.There are relatively few intraoperative and postoperative complications and low reoperation rate,which is a safe and effective option for the treatment of CACG patients with cataract.