Study On Different Surgical Therapy Of PACD Anatomy Based On Cataract

Objective:To compare the anterior ocular biometric characteristics in healthy Chinese subjects and primary angel closure disease(PACD) patients.Methods:A total of 53 healthy subjects(106eyes) and 113 PACD patients(113eyes) in the Chongqing Daping hospital were enrolled. The anterior ocular biometric characteristics included central anterior chamber, anterior chamber angle, iris and lens were measured by anterior segment optical coherence tomography(AS-OCT), and all the data were analyzed with Zhongshan Angle Analysis Program(ZAAP) soft.Results:Forty patients(40eyes) were in PACS group, 32(32eyes) in PAC, 41(41eyes) in PACG.The anterior chamber biometric parameters including anterior chamber depth(ACD), anterior chamber width(ACW), anterior chamber area(ACA), and anterior chamber volume(ACV), them were 2.63±0.32 ㎜, 11.54±0.28 ㎜, 19.89±3.25 ㎜2,135.26±31.02 ㎜3 in healthy subjects respectively, And they were 2.01±1.92 ㎜,11.15±0.32 ㎜,13.68±2.47㎜2,87.87±22.69 ㎜3 in PACD patients, respectively(all p<0.001).And anterior chamber angle parameters including angle opening distance(AOD), trabecular–iris space area(TISA), and angle recess area(ARA) AOD500 was 0.34±0.15㎜,AOD750 0.38±0.13 ㎜, and TISA500 was 0.16±0.06 ㎜2 TISA750 0.20±0.11 ㎜2, and ARA was 0.18±0.04 ㎜3 in healthy subjects. And they were 0.17±0.12 ㎜,0.14±0.11 ㎜,0.07±0.06 ㎜2,0.12±0.03 ㎜2,0.10±0.06 ㎜3 in PACD patients, respectively(all p<0.001).Iris curvature(I-Curv) was 0.27±0.15 ㎜ and lens vaults(LV) was 485.75±210.07μm in healthy subjects, and them were 0.28±0.16 ㎜, 824.18±273.45μm respectively in PACD patients(all p<0.05).Compared with healthy subjects, PACD patients had smaller anterior biometric parameters(e.g. AOD and TISA) and higher I-CURV and larger lens vaults, and they were correlated with increasing age(p<0.01).Conclusions:Eyes in PACD Patients had smaller anterior chamber and narrower anterior chamber angle parameters and higher I-CURV and larger lens vaults, especially in the female eyes. And the anterior biometric parameters correlated with increasing age.Objective:To compare efficacy and safety of phacotrabeculectomy and sequential surgery in primary angle-closure glaucoma(PACG) coexisted with cataract.Methods:One hundred sixty two PACG patients(162 eyes) were retrospectively analyzed, eighty-seven patients(87eyes) in group A had underwent phacotrabeculectomy with intra-capsular lens(IOL) implantation; and seventy-five patients(75 eyes) in group B had underwent sequential surgery. Best-corrected visual acuity(BCVA), intraocular pressure(IOP), complications and anterior ocular biometric characteristics were measured with anterior segment OCT(AS-OCT).Results:Demographic characteristics of the two groups were similar, with data showing a mean follow-up of 15± 6 months(range 13 to 24 months), in addition to a mean IOP of 12.14±5.32 mm Hg in group A and 11.38±4.06 mm Hg in group B(P=0.84) at the last follow up. Applying the Kaplan-Meier analysis revealed that the cumulative probability of success in both groups was similar(P=0.61). Anterior uveitis and hypotony were the most common complications in group A, whereas Group B experienced shallow anterior chamber with trabeculectomy. With the exception of anterior uveitis, no complications occurred to 11 trabeculectomized eyes. All postoperative measurements of AC showed statisticallysignificant differences in each group according to the preoperative data(P <0.05). However, fewer changes occurred in group B than in group A.Conclusions:Phacotrabeculectomy and sequential surgery exhibit similar IOP reduction, visual recovery, and complications when treating PACG patients with cataract. However, for a wider anterior chamber angle, phacotrabeculectomy has demonstrated higher effectiveness than sequential surgery.Objective:To observe retinal thickness of the macula using Fourier-domain OCT(RTVue 100 OCT) in PACD patients coexist with cataract undergoing filtration and lens extract surgery at different methods.Methods:PACD patients coexist with cataract were enrolled in Daping hospital Chongqing. They were divided into three groups, patients in group A who undergoing phacotrabeculectomy, Group B who undergoing trabeculectomy only, Group C who undergoing phacoemusification. Measurements of retinal thicknesses of the nine macular sectors, which were defined by the Early Treatment Diabetic Retinopathy, were performed preoperatively, 1 week, 1 month, and 3 months after surgery using the RTVue-100 OCT technique with MM6 pattern.Results:Eighty seven eyes of 87 PACG patients with cataract undergoing phacotrabeculectomy in Group A, and 75 eyes of 75 PACG patients with cataract undergoing filtration surgery, and 62 eyes of 62 PAC patients with cataract undergoing phacoemusificaiton.Demographic characteristics of the two groups were similar.The post-operative mean fovea thickness at 1 week, 1 month and 3 months were significantly higher than at baseline in Group A(205.33±15.27μm, 189.42±11.35μm, 187.33±12.33μm respectively, versus166.43±17.25μm, P <0.001),Similar change with the superior segment of parafovea thickness at 1 week, 1 month and 3 months(205.33±15.27μm, 189.42±11.35μm,187.33±12.33μm respectively,versus166.43±17.25μm, P <0.001),and the temporal, nasal and inferior segment were higher than the baseline values also, and they reached the baseline value after 3 months.Compared with fovea thickness of 3 groups with SNK-q test, group A >group B >group C(all P <0.05).Also, the postoperative thickness of4 perifovea segments, less change in group C than group A and B at 1 week(all P<0.05). While, compared with the baseline value after 3 months, no statistical value was found(all P>0.05).The edema of macular was correlated with mitomycin C and hypotony both group A and B, But the BCVA was not associated with the edema of macular in Group C(P>0.05).Conclusions:Macular thickening after glaucoma filtering and/or lens extract surgery will increase at the fovea, parafovea and perifovea. And they correlated with mitomycin C and hypotony after filtering surgery, especially phacotrabeculectomy. The BCVA was not associated with the edema of macular, but the cataract extraction.