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The timing of goniosynechialysis in treatment of primary angle-closure glaucoma combined with cataract.

Yu J, Sun M, Wei Y, Cai X, He C, An X, Ye J - Mol. Vis. (2012)

Bottom Line: One anti-glaucoma medicine- was used for 1 eyes.Narrow anterior chamber angles in different extents also were observed in 4 eyes in Group B.However, there was no difference in the center anterior chamber's depth between these groups at the different points in time mentioned above.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Research Institute of Surgery & Daping Hospital, Third Military Medical University, Chongqing, P.R. China.

ABSTRACT

Purpose: To compare the clinical effects of phacoemulsification (PHACO) combined with goniosynechialysis (GSL) at different times in the treatment of primary angle-closure glaucoma (PACG) combined with cataract.

Methods: Before surgery, one or more different kinds of anti-glaucoma medicines were used for 24 patients (32 eyes) of PACG combined with cataract. A combination of PHACO with GSL procedures were performed on both groups of patients. The patients were randomly divided into two groups: 17 patients with 21 eyes were in Group A (GSL performed before lens was removed) and 7 patients with 11 eyes in Group B (GSL after extraction of crystal cortex). Changes in visual acuity, intraocular pressure (IOP) and the depth of the center anterior chamber were observed before surgery and again at 1 month, 3 months, 6 months, and 12 months after surgery.

Results: The mean visual acuity of Group A and Group B was 1.13±0.75 and 0.93±0.50, respectively. There was no statistical difference between these two groups in visual acuity before surgery. At 1 month, 3 months, 6 months, and 12 months after surgery, the visual acuities in Group A were 0.57±0.33, 0.42±0.24, 0.30±0.23, 0.35±0.28 and the visual acuities in Group B were 0.68±0.60, 0.38±0.15, 0.40±0.17,0.33±0.13, and 0.37±0.06. Visual acuity after surgery was greatly improved in both groups. However, there was no difference between these two groups at the different points in time mentioned above. The mean IOP before surgery was 35.67±12.31 mmHg and 31.64±15.06 mmHg for Group A and Group B, respectively. At 1 month, 3 months, 6 months, and 12 months after surgery, the IOP were normalized and were significantly lower than before surgery, in group A and B. However, there was no difference in IOP between these groups at the different points in time as mentioned above. One year after surgery, the percentages of success in Group A and Group B were 86.0% and 90.0%, respectively, qualified success rates in Group A and Group B were 9.5% and 10.0%, respectively. The failure rate in Group A was 4.8%, and no one failed in Group B. In Group A, the number of medications pre-operation was 2.05±0.74. A trabeculectomy was performed on 1 eye, and anti-glaucoma medicines were used for 2 eyes after surgery to normalize IOP. In Group B, the number of medications pre-operation was 2.18±0.87. One anti-glaucoma medicine- was used for 1 eyes. In different period after surgery, anterior chamber angles in Group A were all open. Narrow anterior chamber angles in different extents also were observed in 4 eyes in Group B. The mean depth of the center anterior chamber before surgery was 1.56±0.37 mmHg and 1.72±0.35 mmHg for Group A and Group B, respectively. At 1 month, 3 months, 6 months and 12 months after surgery, the center anterior chamber was deeper than that before surgery both in both groups . However, there was no difference in the center anterior chamber's depth between these groups at the different points in time mentioned above.

Conclusions: For PACG patients with cataracts, surgery methods are shown to improve visual acuity, decrease IOP, and expand the anterior chamber angle. Regarding the opening extent of the anterior chamber angle, surgery performed on Group A achieved better results than Group B.

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The group A show the chamber angle are opening at 12 month after operation (in terms of UBM).
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f10: The group A show the chamber angle are opening at 12 month after operation (in terms of UBM).

Mentions: Clinically, more and more doctors begin to accept PHACO combined with GSL as the usual surgery to treat PACG with cataract [9,10]. The general outcome of the surgery was positive with few side effects. Most patients no longer needed to use anti-glaucoma medicines, which could in turn result in less financial stress for them. However, there still remains the question of when to perform this surgery to achieve the best results. According to the documentations [2,4,9-11], all the doctors choose to perform GSL after phacoemulsification, and the rate of success varied [12-14]. Through clinical observation during the surgery, we find that the central anterior chamber in Group B was significantly deeper than in Group A during the surgery. This may be the reason why so many surgeons prefer to perform GSL after the crystalline lens is removed. After surgery, the results of UBM and Pentacam examinations showed that the central anterior chambers of patients in Group B are truly deeper than those in Group A, but the opening degree of the chamber angle (Figure 9) is poorer than those in Group A (Figure 10). In Group B, the iris roots of some patients are not sufficiently separated. The reasons for this might be that when GSL is performed on patients in Group B, the lens is not available, as the supporting points and the motion space at the pupillary margin for the iris is quite large. When a certain amount of viscoelastic material was filled in, the iris went down and the force acted on the chamber angle is reduced. Some researchers [4] reported that when GSL was performed after the crystalline lens was removed, synechia was appreciably smaller than before surgery according to gonioscope examinations during surgery. Mechanically pressing at the top of the iris root to separate PAS, synechiae at the root of the iris was found through an examination with a gonioscope, which may impair the root of the chamber angle or the iris root and cause certain impairment to the trabecular meshwork. According to the report, the ratio of bleeding in angle separation, caused by pressing the iris root with a blunt instrument, is about 11% [12]. We find that the opening degree of a chamber angle was preferable when the iris root was pressed with instruments in Group B. Additionally, when the complications mentioned above occurred easily, the surgical operation was more difficult to perform. The opening degree of the chamber angle gradually decreased with time in group B. At 12 months after the surgery, the examinations of 4 eyes in 3 patients showed that the opening degrees were significantly smaller than those at 1 month after surgery. The IOP of 2 eyes increased to 20 mmHg. The results of UBM and Pentacam examinations showed that that opening degree of the anterior chamber angle at 12 months after surgery was significantly smaller than at one month post-surgery. As the patients did not return for regular visit, as required, we were not sure whether the close-up of the chamber angle was caused by the anterior chamber's inflammation, the chamber’s bleeding after the surgery, or by the surgery itself [15].


The timing of goniosynechialysis in treatment of primary angle-closure glaucoma combined with cataract.

Yu J, Sun M, Wei Y, Cai X, He C, An X, Ye J - Mol. Vis. (2012)

The group A show the chamber angle are opening at 12 month after operation (in terms of UBM).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3351415&req=5

f10: The group A show the chamber angle are opening at 12 month after operation (in terms of UBM).
Mentions: Clinically, more and more doctors begin to accept PHACO combined with GSL as the usual surgery to treat PACG with cataract [9,10]. The general outcome of the surgery was positive with few side effects. Most patients no longer needed to use anti-glaucoma medicines, which could in turn result in less financial stress for them. However, there still remains the question of when to perform this surgery to achieve the best results. According to the documentations [2,4,9-11], all the doctors choose to perform GSL after phacoemulsification, and the rate of success varied [12-14]. Through clinical observation during the surgery, we find that the central anterior chamber in Group B was significantly deeper than in Group A during the surgery. This may be the reason why so many surgeons prefer to perform GSL after the crystalline lens is removed. After surgery, the results of UBM and Pentacam examinations showed that the central anterior chambers of patients in Group B are truly deeper than those in Group A, but the opening degree of the chamber angle (Figure 9) is poorer than those in Group A (Figure 10). In Group B, the iris roots of some patients are not sufficiently separated. The reasons for this might be that when GSL is performed on patients in Group B, the lens is not available, as the supporting points and the motion space at the pupillary margin for the iris is quite large. When a certain amount of viscoelastic material was filled in, the iris went down and the force acted on the chamber angle is reduced. Some researchers [4] reported that when GSL was performed after the crystalline lens was removed, synechia was appreciably smaller than before surgery according to gonioscope examinations during surgery. Mechanically pressing at the top of the iris root to separate PAS, synechiae at the root of the iris was found through an examination with a gonioscope, which may impair the root of the chamber angle or the iris root and cause certain impairment to the trabecular meshwork. According to the report, the ratio of bleeding in angle separation, caused by pressing the iris root with a blunt instrument, is about 11% [12]. We find that the opening degree of a chamber angle was preferable when the iris root was pressed with instruments in Group B. Additionally, when the complications mentioned above occurred easily, the surgical operation was more difficult to perform. The opening degree of the chamber angle gradually decreased with time in group B. At 12 months after the surgery, the examinations of 4 eyes in 3 patients showed that the opening degrees were significantly smaller than those at 1 month after surgery. The IOP of 2 eyes increased to 20 mmHg. The results of UBM and Pentacam examinations showed that that opening degree of the anterior chamber angle at 12 months after surgery was significantly smaller than at one month post-surgery. As the patients did not return for regular visit, as required, we were not sure whether the close-up of the chamber angle was caused by the anterior chamber's inflammation, the chamber’s bleeding after the surgery, or by the surgery itself [15].

Bottom Line: One anti-glaucoma medicine- was used for 1 eyes.Narrow anterior chamber angles in different extents also were observed in 4 eyes in Group B.However, there was no difference in the center anterior chamber's depth between these groups at the different points in time mentioned above.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Research Institute of Surgery & Daping Hospital, Third Military Medical University, Chongqing, P.R. China.

ABSTRACT

Purpose: To compare the clinical effects of phacoemulsification (PHACO) combined with goniosynechialysis (GSL) at different times in the treatment of primary angle-closure glaucoma (PACG) combined with cataract.

Methods: Before surgery, one or more different kinds of anti-glaucoma medicines were used for 24 patients (32 eyes) of PACG combined with cataract. A combination of PHACO with GSL procedures were performed on both groups of patients. The patients were randomly divided into two groups: 17 patients with 21 eyes were in Group A (GSL performed before lens was removed) and 7 patients with 11 eyes in Group B (GSL after extraction of crystal cortex). Changes in visual acuity, intraocular pressure (IOP) and the depth of the center anterior chamber were observed before surgery and again at 1 month, 3 months, 6 months, and 12 months after surgery.

Results: The mean visual acuity of Group A and Group B was 1.13±0.75 and 0.93±0.50, respectively. There was no statistical difference between these two groups in visual acuity before surgery. At 1 month, 3 months, 6 months, and 12 months after surgery, the visual acuities in Group A were 0.57±0.33, 0.42±0.24, 0.30±0.23, 0.35±0.28 and the visual acuities in Group B were 0.68±0.60, 0.38±0.15, 0.40±0.17,0.33±0.13, and 0.37±0.06. Visual acuity after surgery was greatly improved in both groups. However, there was no difference between these two groups at the different points in time mentioned above. The mean IOP before surgery was 35.67±12.31 mmHg and 31.64±15.06 mmHg for Group A and Group B, respectively. At 1 month, 3 months, 6 months, and 12 months after surgery, the IOP were normalized and were significantly lower than before surgery, in group A and B. However, there was no difference in IOP between these groups at the different points in time as mentioned above. One year after surgery, the percentages of success in Group A and Group B were 86.0% and 90.0%, respectively, qualified success rates in Group A and Group B were 9.5% and 10.0%, respectively. The failure rate in Group A was 4.8%, and no one failed in Group B. In Group A, the number of medications pre-operation was 2.05±0.74. A trabeculectomy was performed on 1 eye, and anti-glaucoma medicines were used for 2 eyes after surgery to normalize IOP. In Group B, the number of medications pre-operation was 2.18±0.87. One anti-glaucoma medicine- was used for 1 eyes. In different period after surgery, anterior chamber angles in Group A were all open. Narrow anterior chamber angles in different extents also were observed in 4 eyes in Group B. The mean depth of the center anterior chamber before surgery was 1.56±0.37 mmHg and 1.72±0.35 mmHg for Group A and Group B, respectively. At 1 month, 3 months, 6 months and 12 months after surgery, the center anterior chamber was deeper than that before surgery both in both groups . However, there was no difference in the center anterior chamber's depth between these groups at the different points in time mentioned above.

Conclusions: For PACG patients with cataracts, surgery methods are shown to improve visual acuity, decrease IOP, and expand the anterior chamber angle. Regarding the opening extent of the anterior chamber angle, surgery performed on Group A achieved better results than Group B.

Show MeSH
Related in: MedlinePlus