Objective To use anatomical parameters as one of the references for primary angle-closure glaucoma (PACG) surgery; to discuss surgical indications by monitoring the clinical results from three surgical methods and related factors. Methods This was a retrospective case series study. One hundred ninety-one eyes of 164 patients who were diagnosed with PACG between February 2008 and January 2009 in Qingdao Eye Hospital were divided into an acute group (91 patients, 91 eyes) and a chronic group (73 patients, 100 eyes). Patients with conditions such as hypertension, diabetes, and other causes of eye disease were excluded from the study. Fewer than 3.2% of the patients were lost at the time of any follow-up visit. Based on expert consensus and differences in anatomical parameters, all groups included patients who underwent trabeculectomy (54 cases, LT=4.77±0.50 mm), phacotrabeculectomy (57 cases, LT=5.02±0.61 mm) and phacoemulsification (53 cases, LT=5.02±0.37 mm). The mean follow-up period was 3.05±0.12 years. Statistical data included age, gender, course of disease, anatomical parameters, follow-up visual acuity, intraocular pressure, and complications after surgery. SPSS 17.0 was used to analyze the anatomical parameters, the Kruskal-Wallis test was used to analyze IOP fluctuation from the three surgeries, the Wilcoxon matched pairs signed-ranks test was used to compare preoperative and postoperative indices, a chi square test or Fisher′s exact test were used to compare postoperative filtering bleb and complications. Results Postoperative intraocular pressure decreased significantly with the three surgeries, and the differences were statistically significant (Z=2.201, P<0.05). Postoperative IOP with phacotrabeculectomy was lower than with the other two procedures and the difference was statistically significant (LSD-t: P<0.05). There were no significant differences in postoperative IOP fluctuation for the three surgeries. The reopening angle accounted for 38% (phacoemulsification) and 22% (phacotrabeculectomy) and the acute group was higher than the chronic group (?字2=6.310, P<0.05). MD and PSD were not significantly different compared to preoperative levels. Complications were not significantly different among the three operations nor was bleb morphology different between phacotrabulectomy and trabulectomy. Although half the patients had no obvious filtering bleb, IOP was lower than 21 mmHg. Conclusion In PACG, with a shorter axial length and thicker lens, the lens can be removed when combined with trabeculectomy. IOP control is better in phacotrabeculectomy. The residual subscleral filtration tract may have a real function in the outflow of aqueous humor.
王亚尼,孙伟,谢立信. 参考解剖学特征选择三种手术方式治疗PACG的临床观察[J]. 中华眼视光学与视觉科学杂志, 2014, 16(10): 589-593.
Wang Yani,Sun Wei,Xie Lixin. A discussion of three surgical methods for primary angle-closure glaucoma based on anatomical parameters. Chinese Journal of Optometry Ophthalmology and Visual science, 2014, 16(10): 589-593. DOI: 10.3760/cma.j.issn.1674-845X.2014.10.004
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