Clinical effect of anterior chamber puncture combined with two different methods in the treatment of primary acute angle closure glaucoma with cataract
LI Chao DU Shaolin CHEN Hongjia MA Huihui
Department of Ophthalmology, Dongguan Tungwah Hospital, Guangdong Province, Dongguan 523000, China
Abstract Objective To observe the clinical effect of anterior chamber puncture combined with two different methods in the treatment of primary acute angle closure glaucoma with cataract. Methods A total of 68 patients with primary acute angle closure glaucoma with cataract in Dongguan Tungwah Hospital, Guangdong Province from June 2018 to June 2020 were selected as the research subjects. According to random number table method, they were divided into group A and group B, with 34 cases in each group. After anterior chamber puncture, group A was treated with phacoemulsification + intraocular lens implantation + goniosynechialysis, group B was treated with trabeculectomy. Visual acuity (converted from international standard visual acuity to LogMAR visual acuity), intraocular pressure, corneal endothelium count, retinal nerve fiber layer (RNFL) thickness, atrial angle open range and central anterior chamber depth (ACD) were recorded and compared between two groups before and three months after surgery. The incidence of complications in two groups was observed. Results Before surgery, there were no significant differences in visual acuity (LogMAR), ACD, atrial angle open range between two groups (P > 0.05). At three months after surgery, the visual acuity (LogMAR), ACD, atrial angle open range of group A were higher those that before surgery, and group A was higher than group B, and the differences were statistically significant (P < 0.05); while the visual acuity (LogMAR), ACD, atrial angle open range of group B were not significantly differences from those before surgery (P > 0.05). Before and three months after surgery, there was no significant difference in intraocular pressure between two groups (P > 0.05). Three months after surgery, intraocular pressure of two groups were lower than those before surgery, and the differences were statistically significant (P < 0.05). There were no significant differences in RNFL thickness between two groups before and three months after surgery (P > 0.05). Before surgery, there was no significant difference in corneal endothelium count between two groups (P ＞ 0.05). Three months after surgery, corneal endothelium count in group A was lower than that before surgery, and group A was lower than group B, and the differences were statistically significant (P < 0.05); while corneal endothelium count of group B was not significantly difference from that before surgery (P > 0.05). There was no significant difference in the incidence of complications between two groups (P > 0.05). Conclusion Anterior chamber puncture combined with two different methods can reduce intraocular pressure and protect visual function, but combined with phacoemulsification + intraocular lens implantation + goniosynechialysis can effectively increase anterior chamber depth and improve visual acuity, which is worthy of further clinical application.
LI Chao DU Shaolin CHEN Hongjia MA Huihui. Clinical effect of anterior chamber puncture combined with two different methods in the treatment of primary acute angle closure glaucoma with cataract[J]. 中国医药导报, 2021, 18(21): 105-109.
[1] Wang YX，Xu L，Yang H，et al. Prevalence of glaucoma in North China：the Beijing Eye Study [J]. Am J Ophthalmol，2010，150（6）：917-924.
[2] 林运志，赵伟，姚勇.超声乳化联合前房角分离术治疗合并老年性白内障的闭角型青光眼疗疗效观察[J].临床眼科杂志，2019，27（1）：30-33.
[3] Lachkar Y. Acute angle closure and angel closure glaucoma：Phacoemulsification as first-line treatment [J]. J Fr Dophtalmol，2010，33（4）：273-278.
[4] Azuara-Blanco A，Burr J，Ramsay C，et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma（EAGLE）：a randomised controlled trial [J]. Lancet，2016，388（10052）：1389-1397.
[5] 中华医学会眼科学分会青光眼学组.中国原发性闭角型青光眼诊治方案专家共识（2019年）[J].中华眼科杂志，2019，55（5）：325-328.
[6] 中华医学会眼科学分会青光眼学组，中国医师协会眼科医师分会青光眼学组.中国青光眼指南（2020年）[J].中华眼科杂志，2020，56（8）：573-586.
[7] 高莎莎，秦廷玉，赵琳.有无视网膜病变的糖尿病患者白内障手术后黄斑水肿发生率比较及相关因素分析[J].中华眼底病杂志,2017，33（33）：593-596.
[8] 梁景黎，邢秀丽，杨晓彤，等.2.2mm和3.0mm透明角膜切口超声乳化白内障吸除术后全角膜及角膜前后表面术源性散光的比较分析[J].中华眼科杂志，2019，55（7）：495-501.
[9] Aung T，Tow SL，Yap EY，et al. Trabeculectomy for acute prmiary angle closure [J]. Ophthalmology，2000，107（7）：1298-1302.
[10] Aung T，Nolan WP，Machin D，et al. Anterior chamber depth and the risk of primary angle closure in 2 East Asian Populations [J]. Arch Ophthalmol，2005，123（4）：527-532.
[11] Lam DS，Chua JK，Tham CC，et al. Efficacy and safety of immediate anterior chamber Paracentesis in the treatment of acute primary angle-closure glaucoma：a pilot study [J]. Ophthalmology，2002，109（1）：64-70.
[12] 赵春梅，刘湘云，李筱荣，等.闭角青光眼急性发作不同时期前房穿刺术效果[J].中华眼外伤职业眼病杂志，2013， 35（7）：533-536.
[13] 周斌，刘洪，曾流芝，等.前房穿刺放液术处理急性闭角型青光眼急性发作32例报道[J].重庆医学，2009，38（13）：1634-1635.
[14] 王淑莉，陈红玲，黄宝玲，等.原发性闭角型青光眼持续高眼压状态下的手术时机探讨[J].眼科新进展，2011， 3l（6）：585-587.
[15] Rodrigues IA，Alaghband P，Beltran Agullo L，et al. Aqueous outflow facility after phacoemulsification with or without goniosynechialysis in primary angle closure：a randomised controlled study [J]. Br J Ophthalmol，2017， 101（7）：879-885.
[16] Pose-Bazarra S，Azuara-Blanco A. Role of lens extraction and laser peripheral iridotomy in iridotomy in treatment of glaucoma [J]. Curr Opin Ophthalmol，2018，29（1）：96-99.
[17] Napier ML，Azuara-Blanco A. Changing patterns in treatment of angle closure glaucoma [J]. Curr Opin Ophthalmol，2018，29（2）：130-134.
[18] 李梅，谢驰，于燕，等.原发性闭角型青光眼合并白内障行超声乳化人工晶状体植入联合房角分离术的临床观察[J].临床眼科杂志，2018，26（1）：39-43.
[19] Zhao XJ，Yang XX，Fan YP，et al. Comparison of combined Phacoemulsification，intraocular lens implantation，and goniosynechialysis with phacotrabeculectomy in the treatment of primary angle-closure glaucoma and cataract [J]. Asia Pac J Ophthalmol（Phila），2013，2（5）：286-290.
[20] Kameda T，Inoue T，Inatani M，et al. Long-term efficacy of goniosynechialysis combined with phacoemulsification for primary angle closure [J]. Graefes Arch Clin Exp Ophthalmol，2013，251（3）：825-830.
[21] Kiuchi Y，Tsujino C，Nakamura T，et al. Phacoemulsification and trabeculotomy combined with goniosynechialysis for uncontrollable chronic angle-closure glaucoma [J]. Ophthalmic Surg Lasers Imaging，2010，41（3）：348-354.
[22] Coh P，Moghimi S，Chen RI，et al. Lens Position Parameters as Predictors of Intraocular Pressure Reduction After Cataract Surgery in Glaucomatous Versus Nonglaucomatous Eyes [J]. Invest Ophthalmol Vis Sci，2016，57（6）：2593-2599.
[23] Zetterstr?觟m C，Behndig A，kugelberg M，et al. Changes in intraocular pressure after cataract surgery：analysis of the Swedish National Cataract Register Data [J]. J Cataract Refract Surg，2015，41（8）：1725-1729.
[24] Moghimi S，Abdi F，Latifi G，et al. Lens parameters as predictors of intraocular pressure changes after phacoemulsification [J]. Eye（Lond），2015，29（11）：1469-1476.
[25] 杜珊珊，张凤妍，刘旭辉.青光眼小梁切除术后极度浅前房的白内障手术[J].中华眼外伤职业眼病杂志，2019， 41（2）：96-100.
[26] 霍蒙蒙，高雪，宗辉，等.不同青光眼手术治疗对角膜神经影响的研究进展[J].中国当代医药，2021，28（10）：40-43.
[27] 李超，李学喜，李维娜，等.两种方法治疗急性闭角型青光眼合并白内障的疗效对比[J].国际眼科杂志，2015， 15（6）：982-984.
