Офтальмохирургия (Oct 2015)
ROLE AND CLINICAL VALUE OF PHACOMORPHIC COMPONENT IN FORMATION OF PRIMARY CLOSED ANGLE GLAUCOMA IN CASE OF AN EXTENDED LENS FORM (TOWARDS A PROBLEM OF GENESIS OF CLOSED ANGLE GLAUCOMA). Report 2
Abstract
Purpose. To research patterns of disorders development in eye hydrodynamics of patients with primary closed angle glaucoma (PCAG) in case of an extended form of lens and to perform a morphometric assessment of a role of lens diameter and volume in this process.Material and methods. There were investigated 75 eyes (75 patients) with PCAG with a short axial length of an eye, age: 38-80 years. The intraocular pressure (IOP) level on the maximum hypotensive regimen was from 29 to 49mmHg. Two groups were created: the main – 14 eyes – the extended lens form, the comparative group – 61 eyes – the thickened lens form. The group of control included 14 fellow eyes of patients in the main group: axial length index: 21.7Ѓ}0.3mm, IOP level: from 18 to 23mmHg. In all eyes of the main group there was a clinic of an acute attack of glaucoma with the high IOP level – up to 49mmHg, without any tendency to a reduction. In the comparative group the clinic of a chronic PCAG took place.Results and discussion. In the main group a statistically significant extension of a lens diameter was noted: from 10.1 to 10.5mm, compared to the control and comparative groups of (10.34Ѓ}0.06mm versus 9.7Ѓ}0.04mm and 9.9Ѓ}0.05mm respectively, р<0.05). Their second important feature was the proportionality of the axial length of a lens, the depth of anterior chamber with the control data. Besides, in all 14 eyes of the main group the ≪lens equator – ciliary processes≫ distance was minimum versus the control and comparative groups: 0.25Ѓ}0.02mm versus 0.95Ѓ}0.01mm and 0.5Ѓ}0.02mm, respectively (p<0.01). It was caused by the maximum diameter of lens in the main group. Besides in all eyes of the main group and the control group there was only a forward location of ciliary body that was absent in the comparative group. The clinic of angular block formed in all the eyes of the main group was caused by a pressure of the iris root to the trabecula by rotated towards anterior ciliary processes due to a mechanical pressure on them by the lens equator.Conclusions. The clinical course of the PCAG in case of the extended form of a lens was expressed exclusively by an acute attack. An increase in diameter of the lens to the critical values on the background of genetically caused frontal position of a ciliary body (i.e., plateau iris syndrome), a short axial length of an eye create a high risk of an acute PC AG attack.
