ABSTRACT
Objective To compare the feasibility,effectivity and security of modified trabeculectomy in advanced stage angle-close glaucoma with cataract.Methods One hundred and forty-five patients (151 eyes) of advanced stage angle-close glaucoma with cataract were enrolled in this study.Among them,85 patients(91 eyes,observation group) were treated with modified trabeculectomy with the resection of deep scleral resection and 60 patients (60 eyes,control group) were treated with routine trabeculectomy.The visual acuity,intraocular pressure (IOP),type of filtering bleb and postoperative complication were compared.Results There was significant difference in the visual acuity ＜ 0.1,0.4-0.5,＞ 0.5 between after operation for 1 month and before operation in two groups (P ＜ 0.05).but there was no significant difference in the visual acuity 0.1-0.3 (P ＞ 0.05).The IOP before operation in observation group was (29.6 ± 4.1) mmHg (1 mmHg =0.133 kPa),12 months after operation was (13.1 ± 4.9) mmHg,the degree of decrease was (16.6 ± 5.0) mmHg.The IOP before operation in control group was (30.4 ± 6.3) mmHg,12 months after operation was (18.9 ± 3.0) mmHg,the degree of decrease was (10.4 ± 4.0) mmHg.The IOP after operation and the degree of decrease between two groups had significant difference (P ＜ 0.05).The functional filtering bleb(Ⅰ type and Ⅱ type) in observation group was 77 eyes(84.6％,77/91),and 51 eyes(85.0％,51/60) in control group,there was no significant difference (P ＞ 0.05).After operation for 1 month,there was 8 eyes appeared transient hypotony in observation group and 5 eyes in control group,there was no significant difference (P ＞ 0.05).Conclusion The modified trabeculectomy in advanced stage angle-close glaucoma with cataract can reduce IOP more effectively and not increase the intraoperative risk and postoperative complication.
ABSTRACT
Objective To investigate the clinical effects of phacoemulsification with foldable posterior cham-ber intraocular lens implantation in the treatment of primary angle closure glaucoma with cataract .Methods 82 patients(82 eyes) with primary angle closure glaucoma with cataract were selected as the research objects ,and taken the treatment of combination of phacoemulsification and posterior chamber foldable intraocular lens implanta -tion.c The vision,intraocular pressure ,anterior chamber depth and angle opening changes before and after 6 months of operation were ompared ,and the postoperative complications were observed .Results 54 eyes achieved best corrected visual acuity of more than 0.5,12 eyes achieved best corrected visual acuity of 0.4,6 eyes achieved best corrected visual acuity among 0.1 to 0.3 and 6 eyes achieved best corrected visual acuity of less than 0.1.The difference between postoperative best corrected visual acuity and that before operation had significant statistical differences (χ2 =43.244,P<0.01).After having the operation ,the intraocular pressure of acute closed angle glaucoma pre clinic , onset period and chronic angle closure glaucoma had significantly improved compared to pre -operation ( t=7.955, 4.741,5.638,all P<0.01).The chamber depth of the three groups had also improved substantially compared to that of pre-operation(t=13.080,11.890,16.124,all P<0.01).The degree of angle opening of acute closed angle glau-coma and chronic angle closure glaucoma were better than that of pre-operation,and postoperatively ,the degree of an-gle opening of the former turned out to be wider than that of the latter (χ2 =9.246,P<0.05).There were no postop-erative intraocular lens clamping,corneal decomposition,severe complication of retinal detachment and macular cys-toids edema .Conclusion The phacoemulsification combined with intraocular lens implantation for the treatment of primary angle closure glaucoma with cataract can effectively improve visual acuity ,control intraocular pressure ,deepen the anterior chamber ,open angle ,and the adverse reactions occurred less ,which is worthy of clinical application .
ABSTRACT
Objective To explore the clinical effects of phacoemulsification with intraocular lens implantation for cataract patients who have had glaucoma and have undergone trabeculectomy before.Methods Phacoemulsification with intraocular lens implantation was performed on 33 patients(38 eyes)with cataract after trabeculectomy.The postoperative visual acuity,intraocular pressure(IOP),filtering bleb,corneal endothelium and complications were observed.Results No posterior capsular rupture occurred and all the lenses were inserted into the capsular bags.Follow up for 3 months at least.The correct visual acuities were≥4.7 in 30 cases(78.9%),≥5.0 in 6 cases(15.8%).Postoperatively,the IOP of all eyes was below 20mmHg and there was no change in the filtering bleb.The loss rate of the corneal endothelial cells was 15.07%after the operation.The density of the postoperative corneal endothelial cells was statistically significant different from those of the preoperative(t=4.582,P＜0.01).The complications occurred more than that of regular phaeoemulsification.Conclusions Phacoemulsification is convenient and effective in patients with cataract after trabeculectomy.The incision should be made without damaging the filtering bleb.The surgery requires skillfully and actively enlarging the small pupils and protecting the corneal endothelium.