RESUMO
BACKGROUND: this study aimed to assess the effectiveness and safety of phaco-endocyclophotocoagulation (phaco-ECP) in patients with glaucoma over five consecutive years. METHODS: Thirty-eight patients (38 eyes) with primary and secondary glaucoma were enrolled to undergo phaco-ECP (Endo Optiks URAM E2, Beaver-Visitec International, Waltham, MA, USA). The primary outcome measures were intraocular pressure (IOP) reduction, success rates, glaucoma medication use, and visual acuity after phaco-ECP. An IOP reduction of 20% compared to the baseline value without re-intervention was considered a successful treatment. Complete success was defined as a cessation of antiglaucoma medications. Secondary outcome measures included intraoperative and postoperative complications. Measurements were performed preoperatively and in the first week and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months postoperatively. RESULTS: The mean ± SD values of IOP preoperatively, at 12, 24, 36, 48, and 60 months postoperatively were 22.6 ± 6.7 mmHg, 15.9 ± 3.9 mmHg (p < 0.001), 15.9 ± 2.9 mmHg (p < 0.001), 15.6 ± 2.7 mmHg (p < 0.001), 15.5 ± 3.8 mmHg (p < 0.001), and 15.2 ± 2.6 mmHg (p < 0.001), respectively. The mean IOP at the last follow-up was reduced by 32.7%. The decrease in the number of antiglaucoma medications was statistically significant at each follow-up visit compared to the baseline. The qualified success rate was 40.6%. All patients at the 60-month follow-up visit required the use of antiglaucoma medications-none of the patients achieved complete success. During the follow-up period, nine patients (28.3%) that required retreatment due to nonachievement of the target IOP were considered failures. Six patients (15.8%) were lost from the follow-up. A total of 23 patients were evaluated 60 months after their phaco-ECP. Complications directly associated with the procedure, such as corneal edema (25.6%), IOP spikes (20.5%), IOL dislocation (2.6%), and uveitis (12.8%), were observed in our patients. Hypotony was not observed in any of our patients. CONCLUSIONS: The phaco-ECP procedure was effective, well-tolerated, and safe for reducing IOP in glaucoma patients with cataracts over a long-term follow-up. Randomized, larger-scale studies are required to validate the results obtained.
RESUMO
PURPOSE: To compare influence of two different cataract surgery methods on corneal thickness. MATERIAL AND METHODS: Prospective, randomized clinical trial with 30 patients undergoing cataract surgery with use of AMO Sovereign Compact-WhiteStar System (15--standard coaxial, 15--microincisional). Central corneal thickness was evaluated by means of Visante OCT (Zeiss Meditec, USA) 1 day before, 1 day, 7 days and 4 weeks after surgery. Equivalent phaco time (EPT) and percentage of phaco power (AVG), was registered after each operation. Surgeons used phaco-chop phacoemulsification technique for nuclear removal. RESULTS: Mean EPT and mean AVG were comparable in both groups. Mean EPT was 8.06 +/- 4.47 (s +/- SD), in standard coaxial-phaco group and 8.94 +/- 5.75 (s +/- SD) in MICS group. Mean AVG was 13.87 _ 5.12% in standard coaxial-phaco group and 12.96 +/- 5.73% in MICS group. Mean central corneal thickness increase 1 day, 7 days, 4 weeks after cataract surgery, was respectively: in standard coaxial-phaco group: 81.23 +/- 53.44 (microm +/- SD), 64.50 +/- 50.75 (microm +/- SD), 4.05 +/- 15.32 (microm +/- SD); in MICS group: 69.09 +/- 48.69 (microm +/- SD), 7.75 +/- 8.24 (microm +/- SD), 2.51 +/- 5.32 (microm +/- SD). CONCLUSIONS: Microincision cataract surgery reduces risk of corneal edema when comparing to standard coaxial phacoemulsification. Visante OCT is a useful method of corneal thickness assessment after cataract surgery.