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G. Tang, L. Wu, J. Lv, C. Wang; The Combined Surgeries of Phacoemulsication, Intraocular Lens Implantation and Goniosynechialysis Improved the Efficacy of Treatment for Patients With Cataract and Primary Angle-Closure Glaucoma. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3965.
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To evaluate the outcome of combined surgeries of phacoemulsication, intraocular lens implantation and goniosynechialysis for patients with cataract and primary angle-closure glaucoma (PACG).
The one hundred and thirty-three patients (145 eyes) simultaneously with cataract and PACG were included in this study. PACG was featured with >180° of peripheral anterior synechiae (PAS) and uncontrolled elevated intraocular pressure (IOP). The patients were divided randomly into two groups: (1) The combined surgeries group: multiple procedures (phacoemulsication, intraocular lens implantation and goniosynechialysis) were performed during surgery; (2) The single surgery group: the trabeculectomy was performed only. IOP, visual acuity, axial anterior chamber depth and the extent of PAS were measured before and after surgery in each group.
Six-nine eyes of 65 patients in the combined surgeries group and 76 eyes of 68 patients in the single surgery group were participated in this study. The postoperative IOP were reduced obviously to 16.55 + 4.36 mmHg vs. 16.87 + 5.01 mmHg when compared to the pre-operative IOP 46.47 + 9.12 mmHg vs. 48.25 + 7.52 mmHg in the combined surgeries group and the single surgery group, respectively. There were very significant differences in IOP deduction between pre and post surgery in both groups (p<0.001). The corrected visual acuity was significant improved from 20/200 to 20/20 after operation compared to 20/2000 to 20/40 before operation in the combined surgeries group (p<0.001). The anterior chamber depth was increased from preoperative 1.55 + 0.26 mm to postoperative 3.38 + 0.35 mm, and the extent of PAS was decreased from pre-operative 290° + 25° to post-operative 60° + 35° in the combined surgeries group and there was very significant differences between pre- and post- surgery in both clinical outcome (p<0.01). In contrast, there were no significant improvements in these clinical outcomes (i.e. visual acuity, anterior chamber depth and PAS) before and after surgery in the single surgery group (p>0.05). Moreover, the patients in the single surgery group required the second surgery of the filtration surgery (2 eyes) or the phacoemulsication and intraocular lens implantation surgery (5 eyes).
The combined surgeries demonstrate more effective for management of patients with cataract and PACG by reducing number of surgery and improving quality of life.
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