Applications of anterior chamber paracentesis with improved compound trabeculectomy for persistent state of high IOP in patients with acute angle-closure glaucoma

Abstract

AIM:To investigate the effect of anterior chamber paracentesis combined with improved compound trabeculectomy for persistent state of high intraocular press(IOP)in patients with acute angle-closure glaucoma(AACG)failed in drug control. METHODS:Thirty-seven AACG patients(37 eyes)with persistent state of high IOP admitted in our hospital from June 2011 to June 2015 were selected. Vision:there was light perception in 2 eyes, hand movement in 3 eyes, finger count in 6 eyes, 0.01 in 8 eyes, 0.05 in 6 eyes, 0.1 in 5 eyes, 0.2 in 3 eyes, 0.25 in 2 eyes, 0.3 in 2 eyes; IOP:40-50 mmHg in 14 eyes, 51-60 mmHg in 11 eyes, 61-70 mmHg in 7 eyes, 71-80mmHg in 5 eyes; Anterior chamber:29 patients gotⅡ grade shallow anterior chamber and 8 patients got Ⅲ grade. After 24-72h of comprehensive ocular hypotensive medications failed to control IOP, paracentesis was applied. At 1-2d after IOP dropped to 21mmHg or less, patients received trabeculectomy combined with goniosynechialysis and mitomycin(MMC). Postoperative systemic and topical anti-inflammatory, anti-infection, symptomatic treatments were applied. RESULTS:Postoperative vision was 0.1-0.2 in 3 eyes, 0.25 in 4 eyes, 0.3 in 6 eyes, 0.4 in 8 eyes, 0.5 in 7 eyes, 0.6 in 6 eyes and 0.8 or more in 3 eyes. Postoperative IOP was controlled within 10-21mmHg without medication in 26 eyes, within 23-27mmHg with 1-2 kinds of anti-glaucoma medications in 8 eyes, 3 eyes failed in drug decompression with 2-3 medications and remained high IOP of 30-38mmHg at last underwent surgery again. The chamber grading was grade Ⅰ in 28 eyes, grade Ⅱ in 6 eyes, Ⅲ grade in 3 eyes. Filtering bleb type was type Ⅰ of functional filtering bleb in 21 eyes, type Ⅱ functional filtering bleb in 13 eyes, type Ⅲ of non-functional filtering bleb in 2 eyes, type Ⅳ of non-functional filtering bleb in 1 eyes. No case occurred complications such as fulminant choroidal hemorrhage, vitreous loss or postoperative malignant glaucoma. There were 3 eyes underwent phacoemulsification cataract combined with IOL implantation and trabeculectomy triple surgery again. CONCLUSION:In statement of persistent high IOP in acute angle-closure glaucoma patients with acute exacerbation, anterior chamber paracentesis combined with improved compound trabeculectomy surgery is effective, safe and feasible, greatly reducing postoperative complications, significantly improving the quality and efficiency of operation, and further improving the success rate of surgery.

Keywords

• persistent high intraocular pressure
• paracentesis
• goniosynechialysis
• trabeculectomy
• mitomycin