Influence of preoperative dilation time on the effect of cataract ultrasonography combined with goniostomy in patients with primary closed angle glaucoma and its clinical significance.

Abstract

Objective: To evaluate the impact of preoperative pupil dilation time on the outcomes of cataract ultrasonoemulsification combined with goniostomy in patients with primary angle-closure glaucoma (PACG).

Methods: A retrospective analysis was conducted on 106 PACG patients who underwent cataract ultrasonoemulsification with goniostomy. Patients were divided into two groups based on pupil dilation times: group A (dilation time between 20 to 30 minutes) and group B (dilation time between 30 minutes to 1 hour). Pre- and postoperative intraocular pressure (IOP), visual acuity, pupil diameter, anterior chamber depth (ACD), and lens thickness (LT) were measured. Surgical time and cumulative dissipated energy (CDE) were also analyzed. Multivariate analysis was performed to identify independent risk factors for postoperative complications.

Results: Both groups showed significant postoperative improvement in visual acuity (P < 0.05). Group B exhibited significantly lower postoperative IOP than group A (P < 0.05). There were significant increases in ACD and pupil diameter and a decrease in LT post-dilation in both groups (all P < 0.05). Group B showed a deeper ACD, thinner LT, and larger pupil diameter compared to group A (all P < 0.05). While CDE was similar between groups, operation duration was longer in group A (P < 0.05). Disease course > 5.5 years, preoperative IOP > 25.14 mmHg, pupil diameter before dilation < 4.895 mm, ACD before dilation < 2.105 mm, and dilation time ≤ 30 minutes were independent risk factors for postoperative complications.

Conclusion: Preoperative pupil dilation time > 30 minutes leads to better surgical outcome. Several preoperative factors, including dilation time ≤ 30 minutes, are independent risk factors for postoperative complications.