A comparison study on goniosynechialysis+ phacoemulsification versus simple phacoemulsification for CPACG with PAS≤180° combined cataract / 中华实验眼科杂志

Objective:To compare the efficacy of phacoemulsification+ goniosynechialysis (Phaco-GSL) and Phaco alone for chronic primary angle-closure glaucoma (CPACG) patients with peripheral anterior synechia (PAS)≤180° combined cataract.Methods:A cohort study was performed.Fifty-two eyes with CPACG in 40 patients who underwent Phaco-GSL and Phaco-alone in Peking Union Medical College Hospital from February 2014 to October 2018 were enrolled.The patients were divided into Phaco-GSL group (22 cases, 29 eyes) and Phaco-alone group (18 cases, 23 eyes) according to different surgeries.Goldmann applanation tonometer was used to measure intraocular pressure (IOP) before operation and 1 day, 1 week and 1, 3, 6, 12, 18 months after operation.Best corrected visual acuity (BCVA) was examined with a standard logarithmic visual acuity chart.The number of anti-glaucoma drugs was calculated in the follow-up duration.The change of PAS was observed by ultrasound biomicroscopy and indentation gonioscopy.The intra- and post-operative complications and their management were analyzed and compared.This research protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Peking Union Medical College Hospital (No.S-K1352). Written informed consent was obtained from each subject prior to any medical examination.Results:There was no significant difference in IOP between the Phaco-GSL group and the Phaco-alone group ( Fgroup=1.569, P=0.223). A significant difference was found in IOP among various time points in different groups ( Ftime=7.762, P<0.01). The IOP of the eyes were significantly reduced at various time points postoperatively in comparison with the preoperative IOP in each group (all at P<0.001). There was no significant intergroup difference in BCVA ( Fgroup=1.996, P=0.172), however, a significant difference was found in BCVA among different time points in both groups ( Ftime=95.737, P<0.01). The postoperative 6- and 18-month BCVA was significantly improved in comparison with before surgery in both groups (all at P<0.001). The number of anti-glaucoma medicines used was significantly decreased at postoperative 1, 6, 12, 18 months in comparison with preoperation in both groups (all at P<0.05), and the anti-glaucoma medicines used in the Phaco-GSL group was less than that in the Phaco-alone group at 6, 12 and 18 months after surgery (all at P<0.05). The ranage of PAS at 18 months after surgery was 45 (0, 90)° and 100 (90, 140)° in the Phaco-GSL group and Phaco-alone group, respectively.The range of PAS in the Phaco-GSL group at postoperative 1, 3, 6, 12, 18 months was significantly smaller than preoperation in the Phaco-alone group (all at P<0.05). The incidence of intra- and post-operative complications in the Phaco-GSL group was significantly higher than that in the Phaco-alone group ( P<0.001). Conclusions:Both Phaco-GSL and Phaco-alone can reduce IOP and improve visual acuity in CPACG with PAS≤180° combined cataract patients.Phaco-GSL can maintain the gonio open and reduce the use of anti-glaucoma medicines and show a good safety.

Single-pass four-throw pupilloplasty for angle-closure glaucoma

Angle-closure glaucoma is characterized by appositional or synechial closure of the anterior chamber angle with glaucomatous field defects that may or may not be associated with a pupillary block. Surgical pupilloplasty with single-pass four-throw technique helps to alleviate the appositional closure along with the breakage of peripheral anterior synechia, thereby increasing the aqueous outflow and decreasing intraocular pressure.

Changes in Anterior Segment Biometry by Laser Iridotomy in Eye With Shallow Anterior Chamber

PURPOSE: To identify the impact of the presence of peripheral anterior synechia (PAS) on the depth of the anterior segment in patients with a shallow anterior chamber after laser iridotomy (LI) by analyzing changes in the anterior segment biometry using ultrasound biomicroscopy (UBM). METHODS: Twenty eyes of 20 patients with PAS and shallow anterior chamber, and another 20 eyes of 20 patients with shallow anterior chamber without PAS were studied. The changes in the anterior segment biometry for each group of patients were examined using gonioscopy and UBM before and after the LI. RESULTS: The central corneal thicknesses and scleral thicknesses of the two groups did not show significant differences (p > 0.05). The anterior chamber depths, anterior chamber angles, trabecular meshwork-iris distances, and angle-opening distances 500 increased significantly after the peripheral LI (p < 0.05) in both groups. However, the difference in the increases in the anterior segment biometries between the two groups was not statistically significant. CONCLUSIONS: LI can increase the depth of the anterior chamber regardless of the presence of PAS.

Peripheral Anterior Synechiae and Ultrasound Biomicroscopic Parameters in Angle-Closure Glaucoma Suspects

PURPOSE: To investigate the correlation between peripheral anterior synechia (PAS) and the quantitative anterior chamber angle parameters measured by ultrasound microscopy (UBM) in angle-closure glaucoma suspect (ACGS) eyes. METHODS: Eyes were defined ACGS as having occludable angles and intraocular pressure less than 21 mm Hg without glaucomatous optic nerve head. The gonioscopic criteria for ACGS were the trabecular meshwork invisible in 3 or more quadrants of the entire angle and the angular width less than 20 degrees by Shaffer classification. Twenty-seven eyes of 20 patients underwent anterior chamber angle and ciliary body imaging with UBM. Angle opening distance (AOD500), angle recess area (ARA), trabecular-ciliary process distance (TCPD) and trabecular-iris angle (TIA) were measured from the UBM images at each quadrant. RESULTS: The AOD500, ARA, and TIA were not significantly different between the eyes with PAS (9 eyes) and without PAS (18 eyes) at each quadrant. However, the TCPD was significantly shorter in the superior quadrant when compared with the eyes without PAS (mean: 405.3+/-70.9 micrometer vs 536.4+/-140.5 micrometer) (p<0.05). CONCLUSIONS: The results suggest that the shorter distance from trabecular meshwork to ciliary body or the anterior placement of ciliary process may play a role in the development of PAS in ACGS eyes.