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NR 4-6/2005
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Ocena skuteczności
operacji wieloproceduralnych w leczeniu współistniejących zaćmy
i jaskry
Efficacy of combined
glaucoma and cataract surgical treatment
Piotr Jurowski, Roman Goś
Z Kliniki Okulistyki i Rehabilitacji Wzrokowej Uniwersytetu
Medycznego w Łodzi
Kierownik: prof. dr hab. n. med. Roman Goś |
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| Summary: |
Purpose: There are
currently some techniques of combined cataract and
glaucoma treatment. They have been under debate for many
years. We present efficacy of different techniques of
combined cataract and glaucoma surgery
Material and methods: 50 patients (60 eyes, 21
male and 29 female), mean age 64.9± 5.6 years enrolled
in the study were divided into 3 groups in which the
combined surgery were performed. Group 1:
phacotrabeculectomy (20 patients, 27 eyes) (FT), group
2: phacoemulsification combined with deep nonperforative
sclerectomy (20 patients, 23 eyes) (FS) and group 3:
phacoemulsification combined with iridocleisis (10
patients, 10 eyes) (FW). Measure outcomes during 6
months of follow up were: value of postoperative
intraocular pressure, visual acuity, pre and
postoperative antyglaucoma medications ratio, intra and
postoperative complications.
Results: There were not differences in
preoperative intraocular pressure (IOP) among group 1
and 2 Significantly higher IOP was assessed in group 3.
Preoperative antyglaucoma medications ratio was the
highest in group 3 (3.5 ± 1.5) as compared with group 1
and 2, (2.0 ± 1.5). Postoperatively mean value of IOP
was significantly lower as compared with the value in
preoperative period in each group. After 3 months of
follow up the IOP lower than 20mmHg was achieved in
81.5% eyes in group 1, 73.9% eyes in group 2 and in 40 %
of eyes in group 3. Six months postoperatively the
target IOP was decreased to 62.9% in group 1 and 65.2%
in group 2 and slightly increased to 50% in group 3.
Postoperative antiglaucoma medications ratio was higher
in group 3 (2.0 ± 1.0), as compared with group 1 and 2,
(1.5 ± 1.0). The best visual acuity after 6 month of
follow up was achieved in group 2, (0.8 ± 0.2). More
severe intraoperative complications such as: anterior
chamber bleeding as well as postoperative complications
eg.: hypotension, inflammation were noticed particularly
in group 1 and 3 and choroidal effusion only in group 1.
Conclusions: Efficacy in lowering of IOP after FT
and FS is the highest within first 3 months
postoperatively. In the late postoperative period the
efficacy of these methods is significantly decreasing
and additional conservative treatment has to be
introduced. Interestingly, the efficacy of IOP
normalization after FW in the late postoperative period
increases. Most of intra and postoperative complications
are link up on FT and FW techniques. Our results suggest
that further investigations and preparing more adequate
indications for surgical strategy among patients with
combined cataract and glaucoma are needed. |
| Słowa kluczowe: |
jednoczesne operacje zaćmy
i jaskry, fakotrabekulektomia, fakoemulsyfikacja z
głęboką nieprzebijającą sklerektomią, fakoemulsyfikacja
z wkleszczeniem tęczówki. |
| Key words: |
combined cataract and
glaucoma surgery, phacotrabeculectomy,
phacoemulsification with deep nonperforating sclerectomy,
phacoiridocleisis. |
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