Clinical Observation Of Pupilloplasty In Acute Angle Closure Glaucoma With Mydriasis

Objective:To observe the clinical effect of pupilloplasty on acute angle-closure glaucoma with mydriasis.Methods:A retrospective analysis of 30 patients(30 eyes)with acute angle-closure glaucoma with dilated pupils who underwent trabeculectomy combined with phacoemulsification and IOL implantation or trabeculectomy combined with phacoemulsification and IOL implantation combined with pupillary plasty in the department of glaucoma,Second Jilin University Hospital from January 2022 to February 2023 was performed.All patients were divided into two groups:the experimental group: the patients diagnosed as acute angle-closure glaucoma with cataract and mydriasis were treated with trabeculectomy combined with phacoemulsification and IOL implantation combined with pupillary plasty in our hospital.Control group: the patients diagnosed as acute angle-closure glaucoma with cataract and mydriasis were treated with trabeculectomy combined with phacoemulsification and IOL implantation in our hospital.Observation items included best corrected visual acuity(BCVA),intraocular pressure(IOP),pupil diameter,anterior chamber depth,angle opening distance 500μm(nasal side,inferior side and temporal side of eye),anterior chamber angle(nasal side,inferior side and temporal side of eye),glare assessment,intraocular lens deviation.All patients were followed up for3 months.The changes of the above observation items in two groups were compared.Results:The best corrected visual acuity(BCVA),intraocular pressure(IOP),pupil diameter,anterior chamber depth,angle opening distance 500μm(nasal side,inferior side and temporal side of eye),anterior chamber angle(nasal side,inf erior side and temporal side of eye)were significantly different between pre-a nd post-operation in the experimental group(P< 0.05).Trabeculectomy combi ned with phacoemulsification and IOL implantation combined with pupillary pla sty can improve the vision,decrease the intraocular pressure(IOP),narrow th e pupil and deepen the anterior chamber of the patients with acute angle-clos ure glaucoma with dilated pupil,nasal,inferior,and temporal side of anterior c hamber angle opening.There were significant differences in the best correcte d visual acuity,intraocular pressure,anterior chamber depth,nasal side angle opening distance 500μm and nasal side anterior chamber angle between preoperation and post-operation in the control group(P < 0.05).Trabeculectomy combined with phacoemulsification and IOL implantation can improve the visu al acuity,decrease the intraocular pressure,deepen the anterior chamber and open the nasal side of anterior chamber angle in patients with acute angle-clo sure glaucoma with mydriasis.But there was no significant difference in pupil diameter,inferior side angle opening distance 500μm,temporal side angle op ening distance 500μm,inferior side anterior chamber angle and temporal side anterior chamber angle between pre-operation and post-operation in control g roup(P > 0.05).There were no significant differences in the best corrected vis ual acuity,intraocular pressure,pupil diameter,anterior chamber depth,angle opening distance 500μm(nasal,inferior,temporal side of eye)and anterior ch amber angle(nasal,inferior,temporal side of eye)between the preoperative p atients in the two groups(P > 0.05).There was no significant difference in the best corrected visual acuity,intraocular pressure,anterior chamber depth,intr aocular lens deviation and deviation between the postoperative patients two g roups(P > 0.05).There were significant differences in pupil diameter,angle op ening distance 500μm(nasal,inferior,temporal side of eye),anterior chamber angle(nasal,inferior,temporal side of eye)and glare assessment between th e two groups(P < 0.05).Pupillary plasty can make the pupil of acute angle-clo sure glaucoma patients with mydriasis narrow,nasal,lower,temporal side of a nterior chamber angle opening increased,and can improve patients’ subjectiv e glare.Conclusion:Pupilloplasty can effectively reduce dilated pupils,improve subjective glar e perception and improve visual quality of life in patients with acute angle-clos ure glaucoma with mydriasis.Pupilloplasty can re-open anterior chamber angl e,prevent the re-adhesion of the anterior chamber angle,is conducive to long-term control of intraocular pressure(IOP).