الفهرس 
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Abstract
pressure and improving visual acuity.
But, some factors could make the use of Phacoemulsification in treating
Angle-closure glaucoma be difficult such as large lens, narrow pupil and the
narrow working space in the anterior chamber .laser Peripheral iridotomy is a
standard procedure commonly used for the treatment of angle closure, it
ameliorates pupillary block ”the common cause of angle closure”.
Laser peripheral iridotomy has been used widely for treating acute or
chronic angle closure by relieving pupillary block, by far the most common cause
of primary angle closure. However, despite being very effective in preventing
symptomatic acute pressure rises in primary angle closure patients who have had
one episode in their fellow eye, it is not completely effective in preventing long
term asymptomatic rises in intraocular pressure.
The main objective of this study was to make a comparison between the
effect of the laser peripheral iridotomy and phacoemulsification on the width of
the anterior chamber angle by ultrasound biomicroscope.
This was a non-randomized clinical trial was carried out on total of 36
eyes of 36 patients from October 2019 through October 2020, in Menoufia
university hospital. Patients of chronic angle closure glaucoma of this study were
divided into two main groups:1. group A: 18 eyes of 18 patients who had
significant cataract and were prepared for phacoemulsification. 2. group B: 18
eyes of 18 patients who didn‟t have significant cataract and were prepared for
laser peripheral iridotomy. All patients before any intervention (pre phaco. or pre
LPI) they were on maximum antiglaucoma medications.
The main results of the study revealed that:
The Phacoemulsification and LPI groups regarding their age and sex as
follows, the mean age of LPI group was less than that of Phacoemulsification
group (51.17±5.59 vs 54.78±5.08 years). And the difference between them
did not reach statistical significance. Also, more than half of the
Phacoemulsification and LPI groups were females (55.56%, 61.10%)
respectively and the difference between them did not reach statistical
significance.
The mean value of IOP Pre phacoemulsification was 24.72±3.10 mmHg,
meanwhile after 1 week of phacoemulsification surgery it was 20.28±3.18
mmHg. Also, after I month it was 16.56± 3.07 mmHg. Thus, there were
highly significant changes of IOP in phacoemulsification group after 1 week
and after 1 month of surgery as compared before surgery.
The average increase in angle opening distance 250 μm was 41.22μm
(42.30±30.55) before surgery and 113.47±4.17 after 1 month of surgery).
Also, angle opening distance 500 μm increased significantly after
phacoemulsification surgery; this increase averaged 172.94 μm
(136.86±36.74 before surgery and 309.81±46.45 after surgery).
Summary
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The mean of IOP decreased from 22.25±2.67mmHg before LPI to
19.500±2.62 mmHg after 1 week of LPI, and 16.67±2.83 mmHg after 1
month of LPI. Thus, there were highly significant changes of IOP in LPI
group after 1 week and after 1 month of surgery as compared before surgery.
The mean AOD 250 increased significantly from 38.53±20.65 Pre LPI to
87.09±15.31 μm Post-LPI with. While, AOD 500 increased significantly
from 117.17±26.51 pre LPI to 180.25±17.53 μm Post-LPI with. The Mean
percent change of AOD 250 and 500 increased by 45.56 and 71.03 μm
respectively.
There was no statistically significant difference between the two groups
regarding IOP after 1 week and after 1 month of surgery.
There was highly statistically significant difference between the two groups
regarding the mean AOD 250 pre and after 1 month of surgery. Also,
regarding the mean AOD 500, there was highly statistically significant
difference between the two groups only after 1 month of surgery. While, there
was no statistically significant difference between the two groups before the
intervention.
There were highly significant changes regarding IOP in phacoemulsification
and LPI groups after 1 week and 1 month of surgery as compared before
surgery. Regarding UBM measurement, a highly significant changes was
found in phacoemulsification group after 1 month of surgery as compared
before surgery. Also, a significant change was found in LPI group after 1
month of surgery as compared before surgery. When compared mean changes
of phacoemulsification with LPI groups, results showed that, mean changers
of IOP after 1 week and 1 month of surgery was not significant. While, mean
changes of AOD 250 and 500 After 1 month of surgery was highly
significantly difference.
There was statistically significant negative correlation between Intraocular
pressure and ultrasound biomicroscopy measurement (AOD 250 and 500)
among Phacoemulsification and Lop groups.
Based on our findings, we recommend for further studies on larger
sample size and on large geographical scale to emphasize our conclusion.