Одномоментная хирургия катаракты и глаукомы с использованием модифицированной антиглаукомной операции

Abstract

Purpose. To develop a modified antiglaucoma operation (MAO) for the combined simultaneous surgical treatment of glaucoma and cataracts and to evaluate the effectiveness of this antiglaucoma component in comparison with trabeculectomy and non-penetrating deep sclerectomy. Material and methods. 61 patients (65 eyes) with a combination of incomplete complicated cataract and previously unoperated POAG stages I–III. The patients were divided into 3 groups: 1st group (control) – 17 patients, 17 eyes with ultrasonic cataract phacoemulsification (PEC) and non-penetrating deep sclerectomy (NPDS); 2nd (control) group (25 patients, 28 eyes) of patients with PE and trabeculectomy (TE); 3rd (main) group (19 people, 20 eyes) – FEC with developed MAO (based on the NGSE technique with cyclodialysis, also including elements of iridocycloretraction and autosclercyclostomy). All patients underwent a comprehensive ophthalmological examination, which included the determination of visual acuity, kinetic perimetry, non-contact tonometry, biomicroscopy, ophthalmoscopy, and optical coherence tomography (OCT). Hypotensive and visual results were assessed a week later and in the long term after surgery. The maximum follow-up period for patients did not exceed 1.5 years (average 12.4 months). Results. Approximately equal hypotensive results in the long-term period were shown by combined operations, which included FEC with TE (absolute effect, i.e. without additional medication – in 65 % of cases) and MAO (respectively, in 60 %). A more modest result was recorded after FEC and NGSE – 41.7 %. However, the number of early postoperative complications after the latter turned out to be almost 2 times less than after simultaneous intervention with penetrating TE (28.5 %), and was quite comparable with that after FEC and NGSE (15 % and 11.8 %). At the same time, the best visual results in the studied terms were observed in the main (0.78 ± 0.06) and 1st control (0.70 ± 0.07) groups, the worst – after FEC (0.64 ± 0.05). Conclusion. Modified antiglaucoma surgery in combination with FEC in POAG surgery and complicated cataract in the long term provides a higher absolute hypotensive effect (60 %) than simultaneous surgical intervention using non-penetrating deep sclerectomy (41.7 %). At the same time, the developed operation is practically not inferior in this indicator to fistulizing trabeculectomy (65 %), but significantly exceeds it both in safety (the number of complications is almost 2 times less) and in visual acuity in the long term (0.78 ± 0.06 versus 0.64 ± 0.05, p < 0.05). Keywords: cataract, glaucoma, simultaneous combined surgery, phacoemulsification, modified antiglaucoma surgery