Effects Of Phacoemulsification, IOL Impantation With Goniosynechialysis In The Management Of Patients With Chronic Angle-closure Glaucoma Using Ultrasound Biomicroscopy

Objectives: The purpose of this study was to evaluate the effectivenessof phacoemulsification, IOL impantation with goniosynechialysis in themanagement of patients with chronic angle-closure glaucoma (CACG) usingUltrasound Biomicroscopy (UBM).Methods: Forty-seven eyes of37recruited chronic angle closureglaucoma patients were collected in our hospital from1st December2010to20th March2012, who were classified into two groups: group A had medicallycontrolled CACG (IOP equal or less than21mmHg) and cataracts comprising25eyes and group B had medically uncontrolled CACG (IOP more than21mmHg with maximum tolerated medications) and cataracts including22eyes.All of the patients had UBM, gonioscopy and fundus examinations.Inclusion criteria were an occludable angle confirmed by UBM andindentation gonioscopy (at least one quadrant without peripheral anteriorsynechia and at the most two quadrants), medically controlled CACG withcataract, or uncontrolled CACG with cataract. Exclusion criteria were uveitis,rubeosis iridis, previous trauma, other glaucomas, and ophthalmic diseasesother than glaucoma and cataract.Group A consists of5males(9eyes) and13females(16eyes), the averageage is61.16years (range49years to70years old); eye: OD/OS=13:12; Thefollow-up time on average is13.24±1.90months;18eyes had glaucomahistory. Group B is consist of22eyes of16cases, including7males (8eyes)and9females (14eyes), whose average age is62.86years (range52to76years old). Eye:OD/OS=12:10; The follow-up time on average is13.14±1.89months;16eyes had glaucoma history.After phacoemulsification, a viscoelastic agent was used for viscogoniasynecialysis. In the last follow-up after the surgery, the bestcorrected visual acuity (BCVA), IOP, the number of topical anti-glaucomamedications, the ACD, the ACA and the amount of the angle that was open inUBM were recorded. Success was defined as IOP≤14mmHg without (relativesuccess) medications and14＜IOP＜21mmHg with or without (absolutesuccess) medications. There were no statistically significant differencesbetween the two groups regarding age,gender and follow-up period.The results are presented as mean±standard deviation and range whereindicated using SPSS19.0systerm. Paired and independent sample t-test andchi-square test were used for statistical analysis. Probability values of less than0.05were considered statistically significant.Results: In group A, the mean IOP and number of medications declinedfrom20.13±0.86mmHg to12.09±1.61mmHg(P＜0.05) and2.08±0.49to0.24±0.52(P＜0.05), respectively. The absolute success rate at the lastfollow-up (13.14±1.89months) was80%and the relative success was20%.No case of visual acuity was decreased after phacoemulsification withgoniosynechiaIysis． The mean central anterior chamber depth was3.47±0.14mm at post-operation, which was deeper than that (2.17±0.26mm)of pre-operation, there was statistical difference(P＜0.05). The anterior anglewas obviously increased after the operation. In group B, the mean IOP andnumber of medications diminished from41.47±9.39mmHg to12.57±3.77mmHg (P＜0.05) and2.59±0.59to0.82±0.96(P＜0.05), respectively. Theabsolute success rate and the relative success was54.55%and40.90%at thelast follow-up (13.14±1.89months).21eyes' s visual acuity was increased andonly1eye of vision had no raising after phacoemulsification withgoniosynechiaIysis. The mean central anterior chamber depth was3.51±0.17mm at post-operation, which was deeper than that (2.03±0.26mm)of pre-operation, there was statistical differences(P＜0.05). The anterior anglewas apparently increased after the operation. Postoperatively, five patientsdeveloped corneal edema and anterior chamber exudation that was treatedusing antibiotic. One patient of Group B failed of the operation and then underwent trabeculectomy successfully.Conclusion:1. Combined phacoemulsification, IOL impantation withgoniosynechialysis is an effective surgical procedure in the treatment ofpatients with CACG and angle restoration whether controlled or uncontrolledby medication.2. UBM can provides us qualitative and quantitative evaluationabout the structures of the anterior and posterior chamber.