RESUMO
Objective:To evaluate the efficacy and safety of phacoemulsification combined with gonioscopy-assisted angle plasty (Phaco-GAAP) for primary angle closure glaucoma (PACG) with cataract.Methods:A case series study was carried out.Twenty-five eyes of 22 patients with PACG and cataract were enrolled in Beijing Tongren Hospital from April 2022 to August 2022.All of the patients received Phaco-GAAP surgery.During the operation, viscoelastic-assisted goniosynechialysis was performed at first, followed by a secondary angle plasty for residual peripheral anterior synechiae (PAS) based on the quantified assessment by gonioscopy, and the extent of PAS was recorded intraoperatively.The operated eyes were followed at 1 day, 1 week, 1 month and 3 months after surgery to evaluate intraocular pressure (IOP), PAS range, the number of anti-glaucoma drugs application, operation-related complications, and success rate.The qualified success rate was defined as medicine-controlled IOP ≤21 mmHg after surgery, and complete success rate was defined as IOP ≤21 mmHg without any anti-glaucoma medication.This study complied with the Declaration of Helsinki and was approved by the Ethics Committee of Beijing Tongren Hospital (TRECKY2021-136). Written informed consent was obtained from each patient prior to entering the research cohort.Results:The extent of PAS was [270(225, 360)°], [165(110, 215)°] and [100(35, 175)°] at preoperation, first and secondary angle plasty, respectively, showing a significant difference among them ( χ2 =40.742, P<0.001). The PAS range was significantly reduced at first angle plasty in comparison with preoperation and was significantly reduced at secondary angle plasty in comparison with at first angle plasty (both at P<0.001), and the proportion of the angle PAS range ≥180° decreased from 48% to 24% after second angle plasty.In 13 eyes finished gonioscopy, the PAS range was [240(195, 305)°], [60(25, 182.5)°], [170(120, 275)°]and [180(140, 280)°]at preoperation, at the end of operation, postoperative 1 month and 3 months, respectively, with a significant difference ( χ2 =23.631, P<0.001). The PAS range was significantly smaller at postoperative 1 month, 3 months than that at preoperation (both at P=0.004) and larger than that at the end of operation ( P=0.011, P=0.003). The IOP was (40.19±17.23), (15.80±7.98), (13.89±5.09), (12.80±3.79) and(13.24±2.78) mmHg before operation and 1 day, 1 week, 1 month and 3 months after operation, respectively, showing a significant difference ( F=44.031, P<0.001), and the IOP was significantly reduced after operation (all at P<0.001). The PAS range at the end of operation was positively correlated with preoperation ( rs=0.409, P=0.042). The complete and qualified success rates were 95.8%, 95.8% for postoperative 1 month, 95.8% and 100% for postoperative 3 months, respectively.The primary complication was intraoperative anterior chamber angle hemorrhage, with an incidence of 68%. Conclusions:Phaco-GAAP can intraoperatively quantify PAS range and guide secondary angle plasty, therefore, it is an effective and safe surgical intervention for PACG with cataract.
RESUMO
Resumo Objetivo: Descrever um caso de glaucoma de ângulo fechado devido a síndrome de íris em platô. Descrição do caso: Paciente do sexo feminino, de 50 anos de idade, que há 13 meses foi tratada de fechamento angular primário a esquerda com sucesso com iridotomia periféria com Nd:YAG laser, compareceu ao serviço com queixa de embaçamento visual e dor intermitentes no olho esquerdo. Ao exame, observou-se fechamento angular à esquerda que se desfazia à gonioscopia de identação e pressão intraocular (PIO) de 16 e 42mmHg. O exame do ângulo da câmara anterior pela tomografia de coerência óptica evidenciou iridotomia patente em ambos os olhos e à esquerda o fechamento aposicional. Pelo estudo das imagens do ângulo foi possível identificar a configuração íris em platô, caracterizando a síndrome de íris em platô à esquerda. Foi procedida a goniosplastia com laser de argônio em ambos os olhos, o que permitiu a correção da configuração da íris e controle da PIO. Após o tratamento, foi realizado exame de campo visual que foi normal à direita e à esquerda identificou escotoma arqueado superior. O fundo de olho mostrou disco óptico normal a direita (0,2),e glaucomatoso à esquerda (0,6). Um ano após a gonioplastia, a acuidade visual foi de 20/30 sem correção por ambos os olhos, PIO de 12 e 13mmHg, sem medicações, com fundo de olho e campos visuais inalterados. Conclusão: A configuração íris em platô deve sempre ser considerada frente a casos de fechamento angular primário, sendo a tomografia de coerência óptica valiosa ferramenta para corroborar no seu diagnóstico.
Abstract Objective: To present a case of closed-angle glaucoma due to Plateau iris syndrome. Case Description: Female Patient, 50 years old, that 13 months ago was treated for primary angular closure to the left successfully with iridotomy with Nd: YAG Laser. She attended the service complaining of visual haze and intermittent pain in the left eye. On examination, it was observed angle closure in the left that could be openned with identation. Intraocular pressure (IOP) of 16 and 42mmHg respectively. The examination of the anterior chamber angle by optical coherence tomography showed patent iridotomy in both eyes and on the left the apositional angle closure. By studying the angle images it was possible to identify plaeau iris configuration, characterizing the iris syndrome of plateau iris. Gonioplasty with argon laser was performed in both eyes, which allowed the correction of iris configuration and control of IOP. After treatment, visual field examination was performed, which was normal to the right and to the left identified superior arcuate scotoma. The Fundus showed a normal right optical disc (0.2), and glaucomatous left (0.6). One year after gonioplasty, visual acuity was 20/30 without correction by both eyes, PIO of 12 and 13mmHg, without medications, with unaltered visual fields and optic discs. Conclusion: The Iris configuration in Plateau should always be considered in front of cases of primary angle closure, being the optical coherence tomography valuable tool to corroborate in its diagnosis.