Extracapsular cataract extraction combined goniosynechialysis acute angle-closure glaucoma_2888

By Edith Stone,2014-10-30 17:37
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Extracapsular cataract extraction combined goniosynechialysis acute angle-closure glaucoma_2888

    Extracapsular cataract extraction combined goniosynechialysis acute angle-closure glaucoma

     Abstract [HTK observation of extracapsular cataract

    extraction with intraocular lens implantation

    goniosynechialysis treatment of cataract combined with acute

    angle-closure glaucoma, and postoperative anterior chamber angle change in the structure. Methods: extracapsular cataract extraction combined goniosynechialysis acute angle-closure

    glaucoma in 34 patients (37), their visual acuity before and

    after surgery, intraocular pressure, vision, central anterior chamber depth, anterior chamber angle morphology of controlled observation. Results: The 180? D after the follow-up, 34 cases

    (37) in 28 patients (30 eyes) compared with the preoperative

    visual acuity improved significantly. Preoperative anterior chamber depth (1.674 ? 0.478) mm, intraocular pressure

    (28.436 ? 3.325) mmHg, after 30? D anterior chamber depth (3.412 ? 0.169) mm, after 7? D intraocular pressure (13.983 ? 5.196) mmHg. After 30? D gonioscopy 34 cases (37) angle are open. 27 patients (28 eyes) after 6 months without narrowing the field of vision reexamination. Conclusion: The extracapsular cataract extraction combined goniosynechialysis such patients can reduce intraocular pressure, deepening the

    anterior chamber, open chamber angle and improve visual acuity.

     Key words extracapsular cataract extraction surgery goniosynechialysis angle-closure glaucoma

     AExtracapsular cataract extraction combined with

     [ABSTRACT] Objective: To investigate the clinical effect of extracapsular cataract extraction combined with goniosynechialysis in treatment of acute angle closure

glaucoma with cataract. Methods: Thirty four patients (37

    eyes) were subjected to this management. The anterior chamber

    depth, visual acuity , configuration of chamber anger, and intraocular pressure were determined. Results: After a mean postoperative follow up of 180 days, the best corrected

    visual acuity was improved in 28 cases (30 eyes). The mean anterior chamber depth was 1.674 ? 0.478 mm pre

    operatively and 3.412 ? 0.169 mm at post operative 30 days

    (t = 6.743, P <0.001). The intraocular pressure was decreased from a pre operative of 28.436 ? 3.325 mmHg to a

    postoperative 7 day of 13.983 ? 5.196 mmHg (t = 5.263, P

    <0.001). Angles of the anterior chamber were opened at post

    operative 30 days in all 34 patients. The visual field was not significantly changed in 15 patients at six months after operation. Conclusion: Extracapsular cataract extraction

    combined with lysis of the synechiae is safe and effective for acute angle closure glaucoma.

     [KEY WORDS] Extracapsular cataract extraction;

    Goniosynechialysis; Glaucoma; Angle closure glaucoma is a

    form of pathological intraocular pressure and visual

    impairment associated with the common blinding eye disease. Angle-closure glaucoma with shallow anterior chamber, narrow angle, and axial length and short features, which increase with age, its relative pupillary block caused by thickening of the lens, while the crystals can be removed to deepen the anterior chamber and open angle Adhesion yet , postoperative intraocular pressure in some patients obtain control, but the angle in patients with solid adhesion did not improve, intraocular pressure was still higher than normal levels. We have acute angle-closure glaucoma with cataract underwent

    cataract extraction and intraocular lens implantation goniosynechialysis will be the clinical indicators before and after surgery to compare the results now reported as follows.

     1 Data and methods

     1.1 General Information option from January 2003 to December 2005 at the Shandong University Qilu Hospital, diagnosed with acute angle-closure glaucoma with cataract

    patients 34 cases (37), of which 11 males (13), female 23

    cases ( 24), 57 76 years, an average of 64 years of age; lens cortical opacity in 23 cases (26), lens nuclear opacity in 6 cases (6 eyes), posterior subcapsular cortical opacity 5 cases

(5 eyes). Surgery before the surgery eye (visual acuity "0.3)

    for routine vision, intraocular pressure, central anterior chamber depth, gonioscopy line perimetry. The higher preoperative IOP, intraocular pressure lowering treatment given to drug. Depth and degree of anterior chamber intraocular lens-specific A measurement applications

    ophthalmic ultrasound measured (the United States, STORZ COMPUSCAN LT), were continuously measured 16 times, the data processed and displayed automatically by a computer print, take the mean registration; vision using automatic perimetry

    (Chongqing, Hong-ASP6000-type) measurements.

     1.2 All surgical operations by a physician with the completion of peribulbar anesthesia. The top of the limbus, after 1? Mm president of 6? Mm scleral tunnel incision in the corner of puncture into the anterior chamber, anterior chamber injection of viscoelastic agents. Under direct vision with viscoelastic injection needle along the angle down slowly into the viscoelastic agent, a continuous injection of addition to the top of the 270 ? angle than would be apparent iris root

    pressure to subside, and use the iris, under gentle pressure bulge Restorer to separate the root of the iris adhesion angle. Followed by continuous curvilinear capsulorhexis, the water separating nuclear and cortex, the nuclear suspension in

    the anterior chamber, his hands France birth to a child of nuclear or nuclear fish out key ring after implantation chamber 5.5? Mm diameter PMMA intraocular lens in the capsular bag. Surgery goes well, without intraoperative posterior

    capsule rupture. There are four cases when the anterior chamber angle in the separation of bleeding, hemostasis after injection of viscoelastic agents.

     1.3 Routine postoperative care given corticosteroid and non-steroidal anti-inflammatory drugs and eye-dilation agents,

    the former three days of oral prednisone and acetazolamide. 1,7,15,30,180 days after the first routine examination, including visual acuity, slit lamp, and intraocular pressure; Article 30,60,180 days with routine examination and gonioscopy; after 6 months follow-vision.

     1.4 Statistical analysis using SAS8.0 statistical software, paired t test.

     2 Results

     2.1 postoperative day 1 IOP of 34 cases (37) The average intraocular pressure (13.896 ? 4.045) mmHg, and preoperative

    mean intraocular pressure (28.436 ? 3.325) mmHg, the

    difference was statistically significant (t = 5.263, P "0.001); the average intraocular pressure after the first 7 days (13.983 ? 5.196) mmHg, the first 180 days (14.562 ?

    3.124) mmHg. Are in normal range.

     2.2 The anterior chamber depth after the first 30 days, the average anterior chamber depth (3.412 ? 0.169) mm and the

    mean preoperative anterior chamber depth (1.674 ? 0.478) mm,

    the difference was statistically significant (t = 6.743, P <0.001).

     2.3 The vision in table 1. Preoperative visual acuity of light perception to 0.5, postoperative best corrected visual acuity 0.04 1.0. 35 compared with the preoperative visual acuity had significantly improved. Table 1 Comparison of visual acuity before and after surgery

     2.4 angle of 37 after 30 days gonioscopy angle are open, 8 trabecular surface pigment scattered coverage. After 90 days and 180 days gonioscopy found no adhesions and closed again.

     2.5 vision after 6 months of records for the 15 eyes,

    visual field compared with preoperative non-shrink. Reposted

    elsewhere in the paper for free download http://

     3 Discussion

     Acute angle-closure glaucoma with cataract, lens opacity will occur when the expansion of the existing shallow anterior chamber of the eye would increase the shallow anterior chamber, close the angle, causing acute closure attack, simple lens extraction with intraocular lens implantation of intraocular pressure can be effectively controlled . But only

    in the onset time than long, anterior chamber angle has been undergoing extensive adhesions were taken only cataract extraction combined with trabeculectomy, mostly for two incisions, greater intraoperative trauma and postoperative response to heavy, post-operative complications were more

    likely to. We use extracapsular cataract extraction combined goniosynechialysis treatment, removed due to lens opacity caused by decreased visual acuity, intraocular pressure, visual acuity is good and fast, ideal postoperative IOP

    control and avoid a number of operations.

     Acute angle-closure glaucoma in patients with the anatomy of the eye of local variation, is recognized as a major pathogenic factors of this disease. This anatomic variation has a genetic predisposition, including a shorter axial length, corneal small, shallow anterior chamber, narrow angle, and the thick lens or a partial position before, so that the pupil margin in close contact with the lens front surface, over the pupil when the aqueous resistance increased posterior chamber pressure is relatively higher than the anterior chamber, pushing the iris forward ectasia, anterior chamber more shallow and narrower angle [1]. Kurimoto et al [2] found by UBM lens iris and lens attached, intraocular lens

    implantation gap between the iris and lens in the lens removed, the anterior chamber depth increased 1.37 times and 1.57 times the angle opening widened. Lens extraction can eliminate a potential cause pupillary block can lead to acute PACG attack factor.

     After the acute PACG attack, both peripheral iridectomy is OK to lift pupillary block, you can also sustained varying degrees of peripheral anterior synechia of iris or angle-

    closure. Gonioscopy estimate the adhesion range. When the peripheral anterior synechia of the iris caused by angle closure Chaoguo 180 ? when the intraocular pressure; Chaoguo 270 ? when the intraocular pressure lowering drug therapy is usually ineffective, need for additional surgery. Goniosynechialysis (goniosynechi alysis, GSL) is the

    peripheral anterior synechia of iris from the angle of separation, restore trabecular features, for the peripheral anterior synechia of iris not more than 1 year of suffering from eye, intraocular pressure control rate of 80 %; for the

    previous line of filtration surgery, or other ocular conjunctival surgery equally effective [3,4]. For the intraocular pressure control in acute angle-closure glaucoma

    OK lens extraction combined with GSL can achieve better efficacy, Tanihara et al [3] reported that lens extraction

    combined with goniosynechialysis surgical treatment of 5-year

    success rate (82.6%) are simple GSL ( 37.6%) of 2 times. Past

    had phacoemulsification plus intraocular lens implantation in the treatment of acute PACG reported [4 6].

     Teekhasaenee, etc. [4] with phacoemulsification and intraocular lens implantation GSL treatment of 42 patients with 52 acute PACG attack less than 6 months continued to have chronic PACG, after 47 (90.4%) without lowering intraocular pressure intraocular pressure drugs "20 ? mmHg, peripheral anterior synechia of iris an average 31% decrease from preoperative to 6%, non-one cases of decreased vision. We have acute angle-closure glaucoma with extracapsular cataract extraction and intraocular lens implantation

    goniosynechialysis achieve better effect. But the follow-up

    time is short, long-term effect of surgery requires further observation.


     [1] is tight, and editor. Ophthalmology [M]. Beijing: People's Health and a community, 1999.107 108.

     [2] Kurimoto Y, Park M, Sakaue H, et al. Changes in the anterior chamber configuration after small incision

    cataract surgery with posterior chamber intraocular lens implantation [J]. Am J Ophthalmol, 1997, 124:775 780.

     [3] Tanihara H, Nishiwaki K, Nagata M. Surgical results and

    complications of goniosynechialysis [J]. Graefes Arch Clin Exp Ophthalmol, 1992, 230:309 313.

     [4] Teekhasaenee C, Ritch R. Combined phacoemulsification and goniosynechialysis for uncontrolled chronic angle closure

    glaucoma after acute angle closure glaucoma [J].

    Ophthalmology, 1999, 106:669 675.

     [5] Ming Zhi Z, Lim AS, Yin Wong T. A pilot study of lens

extraction in the management of acute primary angle closure

    glaucoma [J]. Am J Ophthalmol, 2003, 135:534 536.

     [6] Jacobi PC, Dietlein TS, Luke C, et al. Primary

    phacoemulsificatinon and intraocular lens implantation for acute angle closure glaucoma [J]. Ophthalmology, 2002, 109:1597 1603. Reposted elsewhere in the paper for free download http: / /

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