[Clinical observation of trabeculectomy for primary angle closure glaucoma].

OBJECTIVE: To evaluate the effect of trabeculectomy on intraocular pressure (IOP) and complications in eyes with primary angle closure glaucoma (PACG). METHODS: It was retrospective clinical study. PACG was classified as acute primary angle closure glaucoma (APACG) group and chronic primary angle closure glaucoma (CPACG) group. APACG was then divided into acute attack phase and chronic phase, and CPACG was divided into chronic phase and late phase. IOP, best corrected visual acuity were compared before and after trabeculectomy in different subgroup of PACG. In addition, the incidence of complications of trabeculectomy was assessed. Statistical analyses were performed using SPSS 12.0 statistics software. Categorical variables such as best corrected visual acuity were compared using nonparametric test, continuous variables such as age and IOP were compared between the two groups using independent two-sample t-tests. Pre- and postoperative IOP were compared using one-way analysis of variance of repeated measures. RESULTS: 40 eyes (37 cases) of APACG and 56 eyes (45 cases) of CPACG were enrolled in this study. The median follow-up period was 24 and 25 months, respectively. IOP was significantly decreased from (53.6 +/- 17.9) mm Hg (1 mm Hg = 0.133 kPa, preoperation) to (10.5 +/- 4.9) mm Hg (postoperation) at time of discharging from hospital and (14.0 +/- 10.3) mm Hg at time of final follow up in APACG (F = 100.783, P < 0.01), respectively, and from (36.8 +/- 13.8) mm Hg to (11.7 +/- 4.2) mm Hg at time of discharging from hospital and (13.8 +/- 4.5) mm Hg at time of final follow up in CPACG (F = 54.383, P < 0.01), respectively. The IOP remained controlled (< or = 21 mm Hg) without antiglaucomatous medication in 38 eyes (95.0%) of APACG and in 50 eyes (89.3%) of CPACG. Visual acuity was significantly (H = 12.316, P < 0.01) decreased after trabeculectomy in all sub-types of PACG by Kruskal-wallis analysis. Shallow anterior chamber was commonly occurred after trabeculectomy. CONCLUSIONS: Trabeculectomy is an effective method to control IOP in APACG and CPACG. However, the high proportion of impaired vision was found following trabeculectomy in this study and warranted further clinical investigation.

[Quality of life in patients with primary congenital glaucoma following antiglaucoma surgical management].

OBJECTIVE: To evaluate the 23-item scale of Quality of Life (QOL) for patients with primary congenital glaucoma (PCG). METHODS: It was a cross-sectional study. The QOL scale specific for patients with PCG was firstly evaluated on 51 patients with PCG following antiglaucoma surgery at last followup visit (7.80 years +/- 2.93 years with a median at 7 years) and 50 participants with normal visual acuity (VA) as control. All participants were aged 5-20 years old. The QOL of PCG was evaluated with type of disease, severity, surgical outcome, postoperative VA, age, gender and personality by using single-factor correlation analysis and multiple-factor stepwise regression analysis. RESULTS: The PCG-QOL scale achieved good reliability, validity and responsibility for PCG and 23-item were all qualified for QOL evaluation of PCG. The total scores of QOL in patients with PCG were significantly lower than those of normal individuals (PCG 60.22 +/- 10.02,normal individuals 71.41 +/- 10.11; t = 5.682, P = 0.000). Single-factor correlation analysis showed that the total scores of QOL were associated significantly with the severity of glaucoma (F = 24.026, P = 0.000), surgical outcome (t = 2.638, P = 0.009) and postoperative VA (F = 11.248, P = 0.000); The visual function scores were associated significantly with the severity (F = 12.677, P = 0.000) and postoperative VA (F = 10.369, P = 0.000). The self-care ability scores were associated significantly with the severity (F = 11.064, P = 0.000) and surgical outcome (t = 2.297, P = 0.042). The social and mental scores were all correlated significantly with the severity (F = 6.869, P = 0.020; F = 5.721, P = 0.019) and personality (t = 4.352, P = 0.009; t = 2.297, P = 0.042). Multiple-factor stepwise regression analysis showed that there were significant correlations between total scores and the severity (P3 = -6.985, P = 0.001), postoperative VA (beta = -4.978, P = 0.003) and personality (13 = -5.201, P = 0.020). CONCLUSIONS: The PCG-QOL scale could be used for evaluating the QOL of PCG patients aged 5-20 years. The main factors that influence on the QOL of patients with PCG are severity of the disease, postoperative VA and personality. Preventing progression of glaucoma, improving VA and giving right psychological guidance may improve the QOL of patients with PCG.