| Acute angle-closure glaucoma is a common and important ophthalmic acute disease. If the diagnosis is confirmed, the active treatment measures should be immediately implemented so as to reduce intraocular pressure, to save and protect visual function. Treatment is usually to give enough medication to reduce intraocular pressure to normal at first. Secondly select peripheral iridectomy or trabeculectomy based on the anterior chamber angle fuction. However, in many cases, often encountered serious condition or treatment is late, large-scale of anterior chamber angle is adhered. Persistent ocular hypertension still can't be remission after maximum dose of drugs of corticosteroid and decreasing intraocular pressure is given in a course of treatment 3 to 5 days. Long-term sustained ocular hypertension seriously threaten visual function of patients, surgery becomes the only option. Persistent ocular hypertension caused corneal edema, shallow anterior chamber and severely inflammatory response. It is difficult to operate for glaucoma surgery, many complications can happen during or after operations. The during operation complications include explosive choroidal hemorrhage, lens injury, iris reset difficult etc, and after operation complications include malignant glaucoma, hyphema, severely inflammatory response and choroidal detachment etc. The success rate of surgery is low. To reduce the incidence of surgical complications, improve surgical safety and success rate, many scholars have a long, extensive exploration. Some people advocate of preoperative comprehensive non-surgical therapy and anterior chamber paracentesis, others advocate the slow release of intraoperative fluid or paracentesis. Only a few of domestic scholars reported the method of vitreous aspiration for curing glaucoma. However, there is few reports related to the topic of vitreous aspiration, and no formal study about the comparation of safety and effectiveness between conventional surgical methods and trabeculectomy combined vitreous aspiration surgery. Because of the low incidence of angle closure glaucoma in abroad, acute angle-closure glaucoma persistent ocular hypertension are more rarely, so no related research is founded. In this study, acute angle-closure glaucoma patients of our hospital in recent years are grouped according to the level of intraocular pressure preoperative and anterior chamber depth. Trabeculectomy combined vitreous aspiration; slowly reduce the pressure during trabeculectomy and nomal trabeculectomy, the three different surgical methods were adopted to compare effects and complication rate of different surgical methods. That is in order to find a new relatively safe method to cure the persistent ocular hypertension in acute angle-closure glaucoma.PURPOSE:To evaluate the therapeutic efficacy of different surgeries of acute primary angle closure glaucoma (APACG) in persistent ocular hypertension.METHODS:Inclusion criteria:①The acute angle closure glaucoma patients which undergoing trabeculectomy in our hospital from March 2007 to March 2010.②The patients who have more than 40mmHg (1kPa=7.5mmHg) recorded continuous high intraocular pressure more than 3days before admission in our clinic or outside hospital.③After 3～5d after admission the positive, comprehensive non-surgical treatment. There are 148 patients 148 eyes met the criteria. Measuring of intraocular pressure of all cases with the Goldmann tonometer, measure the depth of the anterior chamber with UBM. according to the different preoperative and intraoperative disposal methods were divided into three groups and using different surgical methods: there is 14 cases 14 eyes in first group, with preoperative intraocular pressure in about 50 mmHg, anterior chamber depth≤1.9mm. Combined vitreous aspiration during trabeculectomy surgery. There are 21 cases 21 eyes in second group, with preoperative intraocular pressure in about 40 mmHg, anterior chamber depth≥2.0mm. Trabeculectomy puncture into the anterior chamber, the tip back and forth, first slowly aqueous humor outflow release IOP then complete trabeculectomy. There is 113 cases 113 eyes in third group, with preoperative intraocular pressure below 30mmHg, anterior chamber depth≥2.0mm operate nomal trabeculectomy. The three groups were retrospectively analyzed and compared the average intraocular pressure of three groups cases on admission, before surgery and at discharge, and three groups of surgical complication rate.RESULTS:148 patients, male 18 cases, female 130 cases. In the first group, the patients' age is 44 to 85 years old, mean 64.71±10.91 years old. Admission IOP is 33.00～81.87mmHg, an average of 58.21±13.12mmHg. Preoperative IOP is 44～67mmHg, average of 48.64±6.79mmHg. Discharge IOP is 5～18 mmHg, an average of 15.91±6.96mmHg. In the second group, the patients' age is 44 to 80 years old, mean 65.52±10.51 years old. Admission IOP is 14.00～81.78mmHg, an average of 49.25±16.15mmHg. Preoperative IOP is 35～55mmHg, average of 39.43±5.71mmHg. Discharge IOP is 2～17mmHg, an average of 10.07±4.51mmHg. In the third group, the patients' age is 24 to 84 years old, mean 63.00±9.93 years old. Admission IOP is 4.85～87.45mmHg, an average of 43.80±23.12mmHg. Preoperative IOP is 6～30mmHg, average of 15.78±6.57mmHg. Discharge IOP is 2～21mmHg, an average of 10.03±3.99mmHg. There was no statistically significant difference of average age and intraocular pressure discharge in the three groups (all P> 0.05). Comparison of intraocular pressure on admission:group 1 is higher than group 3 (P< 0.05). While in Group 1 and Group 2, Group 2 and Group 3, the difference was not statistically significant. Comparison of preoperative intraocular pressure:group 1 the highest, followed by group 2, group 3 the lowest. The surgical complication rates of the three groups were 1/14 (7.10%),10/21 (47.61%),12/113 (10.62%). There was significant difference in the incidence of surgical complications in group1 and group 2. The same situation occurred in group 1 and group 3 (all P< 0.0125). However, there was no significant difference between group 1 and group 3. CONCLUSIONS:Aspiration of vitreous surgery have a significant meaning for reducing the incidence of complications in and after the operation of patients with acute primary angle closure glaucoma (APACG) under persistently high intraocular pressure(IOP). |
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