ABSTRACT
BACKGROUND: The main goals of glaucoma treatment are to preserve the visual function and maintain as high a quality of life as possible at a cost acceptable to society. Therefore, it is crucial to carefully observe each individual patient in order to determine an individual and personalized treatment approach. MATERIAL AND METHODS: This article summarizes the advantages and disadvantages of medicinal glaucoma treatment as well as traditional methods of glaucoma surgery, based on the current state of knowledge. The article explains the various mechanisms of action of new minimally invasive procedures, introduces the methods mostly commonly used in Germany and gives recommendations for preoperative care and postoperative follow-up. RESULTS/CONCLUSION: In addition to the plethora of medicinal glaucoma treatments and classical surgical procedures, new minimally invasive treatment alternatives have become available in the past few years. The latter are an option for an earlier surgical intervention, especially in naïve or previously treated patients who appear to be unsuitable for medicinal treatment.
Subject(s)
Glaucoma , Trabeculectomy , Germany , Glaucoma/drug therapy , Glaucoma/surgery , Humans , Intraocular Pressure , Mitomycin , Quality of Life , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE: To evaluate the efficacy of different treatment modalities in eyes with small pupils before femtosecond laser-assisted cataract surgery. SETTING: Ruhr University Eye Clinic, Bochum, Germany. DESIGN: Prospective clinical trial. METHODS: Eyes with an intraoperative pupil size smaller than 5.5 mm received sequential treatments to achieve a pupil larger than 5.5 mm in 3 steps: (1) intracameral administration of epinephrine solution, (2) additional viscomydriasis, and (3) implantation of a Malyugin ring pupil expander. When a step enlarged the pupil to at least 5.5 mm, femtosecond laser-assisted cataract surgery with an anterior capsulotomy diameter of at least 4.5 mm and 350 µm nuclear fragmentation grids, ultrasound phacoemulsification, and intraocular lens implantation were performed. Main outcome measures were achieved preoperative pupil size in each sequential treatment group and analysis of intraoperative complications. RESULTS: Of 850 eyes scheduled for cataract surgery, 40 received sequential treatments. To achieve a pupil larger than 5.5 mm, epinephrine was sufficient in 7% of the eyes; additional viscomydriasis was necessary in 25%, and the pupil expander was implanted in 68%. The most frequent comorbidities were pseudoexfoliation of the lens capsule (30.0%) and intraoperative floppy-iris syndrome (12.5%). Tongue-like lesions of the capsulotomies were detected in 5 eyes. CONCLUSIONS: The 3-step treatment allowed the surgeon to increase the efficiency and safety of femtosecond-assisted cataract surgery in eyes with a small preoperative pupil, providing good safety margins at the pupil boundary for the capsulotomy and the softened nuclear volume.
Subject(s)
Low-Level Light Therapy/methods , Phacoemulsification/methods , Pupil Disorders/surgery , Aged , Aged, 80 and over , Anterior Capsule of the Lens/surgery , Epinephrine/administration & dosage , Female , Humans , Intraoperative Complications , Male , Middle Aged , Mydriatics/administration & dosage , Prostheses and Implants , Pupil/drug effects , Pupil Disorders/complications , Surgery, Computer-Assisted , Tomography, Optical Coherence , Treatment Outcome , Viscosupplements/therapeutic useABSTRACT
PURPOSE: To quantify changes in endothelial cell counts and corneal thickness measurements in patients having standard phacoemulsification compared with femtosecond laser-assisted cataract removal. SETTING: Ruhr University Eye Clinic, Bochum, Germany. DESIGN: Prospective randomized intraindividual cohort study. METHODS: One eye of each patient had standard phacoemulsification (control group) and the other eye had femtosecond laser-assisted phacoemulsification (study group), both with intraocular lens implantation. Pulsed ultrasound energy was used for phacoemulsification. Noncontact endothelial cell microscopy and corneal pachymetry were performed preoperatively and 1 day, 3 to 4 days, 7 to 10 days, 50 to 60 days, and 90 to 100 days postoperatively. RESULTS: The mean endothelial cell loss was 7.9% ± 7.8% (SD) 1 week postoperatively and 8.1% ± 8.1% 3 months postoperatively in the study group and 12.1% ± 7.3% and 13.7% ± 8.4%, respectively, in the control group. The mean relative change in corneal thickness from the preoperative values was -0.0% ± 1.9% at 1 day, 2.8% ± 1.8% at 1 week, and 3.3% ± 1.7% at 3 months in the study group and -0.9% ± 2.3%, 2.4% ± 1.5%, and 3.2% ± 1.4%, respectively, in the control group. CONCLUSION: The femtosecond laser did not add to the endothelial damage caused by cataract surgery and might be beneficial in eyes with low preoperative endothelial cell values (eg, cornea guttata cases).