Observation on the Functioning of the Anterior Chamber Angle after Combined Glaucoma and Cataract Surgery in the Chronic Phase of Acute Angle-Closure Glaucoma with Cataract

Objective: To investigate the functioning of the anterior chamber angle after combined surgery in the treatment of the chronic phase of acute angle-closure glaucoma with cataract. Methods: A retrospective analysis was performed on 37 patients (37 eyes) in the chronic phase of acute angle-closure glaucoma with cataract who were treated in the glaucoma center of Henan Provincial People's Hospital from November 2017 to March 2018: All patients were treated with drugs after an acute attack for 3-14 days; preoperative intraocular pressure (IOP) was higher than 21 mmHg; gonioscopic examination: angle closure >2 quadrant; ultrasound biomicroscopy (UBM): Anterior chamber shallow, peripheral iris root and trabecular meshwork attachment range >2 quadrant; lens nuclear turbidity ≥Ⅲ. All patients underwent conventional double-incision surgery combined with trabeculectomy, phacoemulsification cataract extraction, intraocular lens implantation, and angle separation. No anti-metabolite drugs were used during the surgery. The scleral flap was tightly closed with an adjustable suture. The best corrected visual acuity (BCVA), IOP, central anterior chamber depth, angle opening range and filtration bleb formation were observed before and after surgery. The Wilcoxon test, analysis of variance, paired t test and Pearson correlation were used to analyze the observation index. Results: At 7 days after surgery: The mean IOP was 18.8±1.7 mmHg, which was significantly lower than IOP before surgery (t=16.562, P 2 quadrants after surgery, and there was no correlation between postoperative IOP and preoperative anterior angle (r=0.016, P=0.926); the depth of the central anterior chamber was deeper than before surgery (t=-25.195, P<0.001); the postoperative BCVA of 33 patients was improved compared with BCVA before surgery, the BCVA of 4 patients did not improve, the difference in BCVA before and after surgery was statistically significant (Z=-5.017, P<0.001); 5 patients had functional filtering blebs formation in the upper conjunctiva, 32 patients had no obvious filtering blebs after surgery, ultrasound biomicroscopy also confirmed that no effective filtering blebs formed under the conjunctiva. Conclusions: For patients in the chronic phase of acute angle-closure glaucoma with cataract, combined trabeculectomy plus cataract surgery plus angle separation can effectively reduce intraocular pressure. The decrease in intraocular pressure is likely to depend on the recovery of the function of the trabecular meshwork, rather than to rely on the establishment of an external filtration channel. Key words: acute angle-closure glaucoma; chronic phase; glaucoma and cataract combined surgery; the function of anterior chamber angle