Tratamento do glaucoma de ângulo fechado sem catarata: novas alternativas terapêuticas

Abstract

This randomized clinical study performed at Hong Kong compares the efficacy of phacoemulsification vs. trabeculectomy operations for treating patients with angle - closure glaucoma (ACG), with uncontrolled intraocular pressure (IOP) and without cataracts that affect vision. Although this article was first published in 2013, its inclusion in the e-oftalmo.cbo database is justified by the clinical relevance in our daily practice. The results and conclusions of this study warrant further discussion so that these patients can be adequately treated. A total of 26 patients with ACG were randomized into the phacoemulsification group, and 24 patients were randomized into the trabeculectomy with mitomycin group (0.4 mg/ml, 2 – 3 minutes). All patients presented with pat ent iridotomies, glaucomatous optic neuropathy, defects in the visual field that were consistent with glaucoma, and an average IOP above 24 mmHg when more than three medications were used. A surgeon specialized in ACG performed all the surgeries, and patie nts were monitored in follow-up consultations every three months for a period of two years. IOP decreased in both the phacoemulsification group (24.1 ± 4.1 mmHg pre-surgery vs. 15.9 ± 3.9 mmHg 24 months post-surgery) and the trabeculectomy group (24.8 ± 3.4 mmHg pre-surgery vs. 5.8 ± 4.3 mmHg 24 months post-surgery); however, more anti-glaucoma medication was required in the phacoemulsification group (the average number of drugs required was 1.5 in the phacoemulsification group and 0.4 in the trabeculectom y group). The trabeculectomy group presented significantly more complications than the phacoemulsification group, as the patients required interventions such as compression bandages, 5 -fluorouracil injections, and needlings. However, no complication in either group resulted in a worse prognosis in terms of vision by the end of the study. According to the study, 8 (33%) eyes from the trabeculectomy group were found to have cataracts, and 5 patients accepted treatment with phacoemulsification. In addition, a total of 5 (20%) patients from the phacoemulsification group experienced uncontrolled intraocular eye pressure, despite clinical treatment; 3 agreed to undergo trabeculectomy. The authors conclude that phacoemulsification alone may be an alternative to trabeculectomy as an initial surgical treatment in cases of ACG with uncontrolled IOP, even in the presence of clear lens.