| Objectives: In this study, the changes of optic disk structures, the depth of retinal nervefiber layer, and vision field after trabeculectomy were measured in patients with primary acuteangle-closure glaucoma (PACG) by using Heidelberg retina tomography scanner (HRT)-III andHumphrey750type automatic measure equipment. The relations between these three parametersand the outcome of surgery were analyzed. Through this present study, we can provide sometheoretical evidences for the surgery of PACG.Methods:(1)Fifty patients who admitted to the department of Ophthalmology of ourhospital from Jan,2011to Jan,2013, were diagnosed as primary acute closed glaucoma (PACG)in one eye, and underwent the surgery of trabeculectomy were retrospectively analyzed in thisstudy. According to IOP the patients were devided into three groups.(2)The structure of opticdisk, the depth of retinal nerve fiber, and the vision field were measured using HRT-III andHumphrey750equipment at the time points of before surgery, two weeks after surgery, and sixmonths after surgery. The parameters of cup area (CA), rim area (RA), cup volume (CV), rimvolume (RV), cup/disk area ratio (C/D AR), mRNFL、temporal、tmp/sup、tmp/inf、nasal、nsl/sup、nsl/inf were all measured in present study. The degree of vision deficiency was judged bycalculating Mean Deviation(MD)、Pattern Standard Deviation(PSD) and76point in the map ofPattern Deviation.Then calculate the average of vision defective percentage in four quadrants(nasal superior, nasal inferior, temporal superior, and temporal inferior) in the map of vision field.(3) Comparing the data of optic disk structure, the depth of retinal nerve, and the vision deficiencybefore and after surgery, we analyzed the relationship between these three parameters and also theeffects of surgery on these three parameters.Results:1. The intraocular pressure (IOP) of the patients in these three groups was all recovered to normal at two weeks or six months after surgery (P<0.05).2. Negative correlation was found between the level of IOP and the depth of retinal nervefiber layer or the rim area, positive correlation was found between the level of IOP and cuparea、MD、PSD in these three groups at six months after surgery.3. In the first group, we found that the rim volume become wider and the retinal nerve fiberlayer of nasal and nasal inferior become thicker at six months after surgery compared beforesurgery. The sphere map of version field was also improved, especially in the quadrants of nasalsuperior, nasal inferior, and temporal superior (p<0.05). In the secondary group, the retinal nervefiber layer of nasal and nasal inferior become thicker and the sphere map of version field was alsoimproved, especially in the quadrants of temporal superior (p<0.05) at six months after surgerycompared before surgery. In the third group, we found that the retinal nerve fiber layer becomesthicker, the rim volume becomes wider, and the optic cup becomes smaller at two weeks aftersurgery compared before surgery (p<0.05). However, six months after surgery, the retinal nervefiber layer in the quadrants of temporal lateral become thinner (p<0.05), but the vision deficiencydid not changed obviously compared before surgery.4. At the six months after surgery, we found significant correlation between the index ofvision field (MD) and rim volume area or cup volume (p<0.05), with the relationship coefficientof-0.989and0.992. But there was no significant correlation between the MD and depth of opticnerve fiber layer.5. At six months after surgery, we found the index of vision field (MD) in all three groupswas declined compared with the results before surgery. In the first and second groups, the indexof vision field (PSD) was decreased compared with the data before surgery, while in the thirdgroup, the PSD was increased (p<0.05).Conclusion:1. In patients with PACG, the level of IOP and the duration of the disease are related to opticnerve damage. In treatment of PACG, we need to decrease the level of IOP as much as possibleand also shorten the duration of higher level IOP.2. Controlling the preoperative IOP and shorting the time of high IOP in PACG patients canimprove the damage of optic nerve fiber. Insufficient in controlling preoperative IOP and high level of IOP for a long time can cause the irreversible damage of optic nerve fiber.3. Visual change is related to the damage of the retinal nerve fiber layer in patients withPACG.4. Optic and retinal edema can be found in PACG patients with persistent high level of IOP,while this kind of edema is reversible. |
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