Eye Hydrodynamics after Combined Treatment of Primary Open-Angle Glaucoma and Complicated Cataract

T V Sokolovskaya,P L Volodin,V N Yashina,V V Teplovodskaya

doi:10.29413/abs.2019-4.4.20

Abstract

Aim: To study hydrodynamics of the eye after combined treatment – a combination of laser activation of trabecula and cataract phacoemulsification – in a comparative aspect.Material and methods. The study included 65 patients (65 eyes) with initial and advanced stages (I–II stages) of primary open-angle glaucoma (POAG) and complicated cataract. Among the patients there were 38 women (58.5 %) and 27 men (41.5 %), the average age was 68.8 ± 8.2 years. The follow-up period is 12 months after the treatment. The patients were divided into two groups: the main one – 33 patients (33 eyes) who underwent combined treatment – YAG-laser activation of trabecula (YAG-LAT) and phacoemulsification of cataract with intraocular lens (IOL) implantation, the control group – 32 patients (32 eyes) who underwent only phacoemulsification.Initially, the average intraocular pressure (IOP) (P0) in the main and control groups was 20.72 ± 3.39 mm Hg and 21.02 ± 3.55 mm Hg respectively. The average number of antihypertensive drugs used in the study group was 1.53 ± 0.64, in the control group – 1.34 ± 0.55.Results. There were no intraand postoperative complications. By the end of the follow-up period, a significant decrease in the average IOP level compared to its preoperative value by 29.2 % was determined in the main group, and 9.8 % in the control. The average number of antihypertensive drugs used in the study group decreased from 1.53 ± 0.64 to 0.67 ± 0.59 (p < 0.05), in the control group of patients, on the contrary, the average number of antihypertensive agents increased from 1.34 ± 0.55 to 1.91 ± 0.70 (p < 0.05).Conclusion. In the long-term postoperative period after combined treatment (YAG-LAT + phaco), IOP normalization was achieved in 96.9 % of cases, as well as a significant increase in visual acuity of patients. The developed method of treatment is safe, has a minimal risk of complications and can be used for the treatment of patients with initial stages of POAG in combination with complicated cataracts with increased IOP level, inefficiency of antihypertensive therapy.

Highlights

In the long-term postoperative period after combined treatment (YAG-LAT + phaco), intraocular pressure (IOP) normalization was achieved in 96.9 % of cases, as well as a significant increase in visual acuity of patients
Современные возможности хирургического лечения больных с сочетанием открытоугольной глаукомы и катаракты

Summary

Conclusion

In the long-term postoperative period after combined treatment (YAG-LAT + phaco), IOP normalization was achieved in 96.9 % of cases, as well as a significant increase in visual acuity of patients. For citation: Sokolovskaya T.V., Volodin P.L., Yashina V.N., Teplovodskaya V.V. Eye hydrodynamics after combined treatment of primary open-angle glaucoma and complicated cataract. Вопрос о выборе тактики лечения пациентов с первичной открытоугольной глаукомой (ПОУГ) и осложнённой катарактой остаётся актуальным до настоящего времени. Что после проведения факоэмульсификации катаракты с имплантацией ИОЛ основным результатом является улучшение остроты зрения, и также отмечается гипотензивный эффект [1]. По результатам ряда исследований снижение ВГД после ФЭК с имплантацией ИОЛ при первичной открытоугольной глаукоме может быть обусловлено расширением трабекулярных пространств в результате натяжения волокон цинновой связки [2], усилением увеосклерального оттока внутриглазной жидкости (ВГЖ) [3] и открытием трабекулярной зоны, ранее не участвовавшей в фильтрации [4]. Актуальным остаётся вопрос разработки комбинированных микроинвазивных способов лечения ПОУГ и осложнённой катаракты, имеющих патогенетическую направленность, безопасных, обладающих высокой клинической эффективностью [15]

МАТЕРИАЛ И МЕТОДЫ

РЕЗУЛЬТАТЫ И ОБСУЖДЕНИЕ

До лечения

Findings

До операции