RESUMEN
PURPOSE: To evaluate the results of phacoemulsification and intraocular lens (IOL) implantation in eyes with pseudoexfoliation (PEX) and zonular weakness. METHODS: Two hundred and ninety-five patients (295 eyes) were recruited. This study is a retrospective case review of 143 PEX eyes with preoperative (Group 1) and intraoperative (Group 2) signs of zonular weakness, 76 PEX eyes (Group 3) and 76 non-PEX eyes without zonular weakness (Group 4) undergoing phacoemulsification and IOL implantation performed by single surgeon from year 1988 to 2010. Outcome measures included frequency of postoperative pseudophakodonesis, anterior capsule contraction and IOL decentration/dislocation. Postoperative vision, intraocular pressure (IOP) and glaucoma medication requirements were also assessed. A subanalysis on identical postoperative outcomes of capsular tension ring (CTR) implantation was performed. Comparisons were made for 52 PEX eyes with zonular weakness receiving nonsutured CTR implantation (Group A), 91 PEX eyes with zonular weakness not receiving CTR implantation (Group B) and 142 PEX eyes without zonular weakness (Group C). RESULTS: Mean follow-up was 4.08 ± 0.48 years and maximum was 8.3 years. Both Groups 1 and 2 showed higher incidence of complications than Groups 3 and 4 (p < 0.01). Vision, IOP and glaucoma medication requirements were similar postoperatively for all four groups. Groups A and B had a significantly higher proportion of postoperative complications than Group C (p < 0.01). There was no significant difference in risk of developing these complications between Groups A and B (p = 0.64). CONCLUSION: Postoperative complication rates are higher in PEX eyes with preoperative and/or intraoperative signs of zonular weakness undergoing phacoemulsification. Nonsutured CTR implantation does not prevent IOL and capsular complications postoperatively.
Asunto(s)
Síndrome de Exfoliación/cirugía , Implantación de Lentes Intraoculares/métodos , Cristalino/diagnóstico por imagen , Facoemulsificación/métodos , Complicaciones Posoperatorias/epidemiología , Anciano , Síndrome de Exfoliación/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Cristalino/cirugía , Masculino , Massachusetts/epidemiología , Oftalmoscopía , Complicaciones Posoperatorias/diagnóstico , Estudios Retrospectivos , Factores de TiempoRESUMEN
PURPOSE: To evaluate safety and clinical outcomes of a novel supraciliary device, the CyPass Micro-Stent, for surgical treatment of open-angle glaucoma when implanted in conjunction with cataract surgery. PATIENTS AND METHODS: Subjects (n=142) with open-angle glaucoma and cataract underwent combined phacoemulsification, with intraocular lens insertion, and microstent implantation into the supraciliary space of study eyes (n=167). Two analysis cohorts were prespecified based upon medicated baseline intraocular pressure (IOP): ≥21 mm Hg (cohort 1, n=65) or <21 mm Hg (cohort 2, n=102). Glaucoma medications were discontinued or tapered at surgery, and restarted at investigator discretion. The main postoperative outcome measures were adverse events, IOP changes, and number of IOP-lowering medications. RESULTS: Mean±SD follow-up was 294±121 days. No major intraoperative or postoperative complications occurred. Preoperative baseline mean IOP was 20.2±6.0 mm Hg and mean number of IOP-lowering medications was 2.0±1.1. Cohort 1 showed a 35% decrease in mean IOP and a 49% reduction in mean glaucoma medication usage; cohort 2 demonstrated a 75% reduction in mean medication usage while maintaining mean IOP<21 mm Hg. For all eyes, mean IOP at 12 months was 15.9±3.1 mm Hg (14% reduction from baseline). Early and late postoperative IOP elevation occurred in 1.2% and 1.8% of eyes, respectively. Two subjects developed mild transient hyphema, and none exhibited prolonged inflammation, persistent hypotony, or hypotony maculopathy. CONCLUSIONS: CyPass Micro-Stent implantation, combined with cataract surgery, resulted in minimal complications and reduced IOP and IOP-lowering medication use at 12 months postoperatively.
Asunto(s)
Implantes de Drenaje de Glaucoma , Glaucoma de Ángulo Abierto/cirugía , Facoemulsificación , Anciano , Anciano de 80 o más Años , Catarata/complicaciones , Femenino , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Presión Intraocular/fisiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Tonometría Ocular , Resultado del Tratamiento , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To report 3-year results evaluating the effect on safety and efficacy of canaloplasty to treat open-angle glaucoma when combined with cataract surgery. PATIENTS AND METHODS: This was a retrospective subset analysis of a prospective, international, multicenter study evaluating 133 eyes of 133 adult, open-angle glaucoma patients who underwent canaloplasty with tensioning suture placement. Eighty-two phakic eyes that received canaloplasty alone were compared with 51 eyes that underwent cataract surgery before or during canaloplasty. RESULTS: Phakic eyes that received combined cataract-canaloplasty surgery (phacocanaloplasty) had a mean±SD baseline IOP of 23.5±5.2 mm Hg and mean glaucoma medication usage of 1.5±1.0 decreasing to a mean IOP of 13.6±3.6 mm Hg on 0.3±0.5 medications at 3 years postoperatively. Pseudophakic eyes undergoing canaloplasty had a mean baseline IOP of 23.9±5.2 mm Hg on a mean of 1.8±0.8 glaucoma medications decreasing to 15.6±3.5 mm Hg on 1.1±0.8 medications at 3 years. In phakic eyes, reductions in IOP were significantly greater and less postoperative IOP lowering medication was needed after undergoing phacocanaloplasty compared to eyes which had canaloplasty alone. CONCLUSIONS: Clear corneal phacoemulsification performed before or in combination with canaloplasty is a safe and effective surgical procedure to reduce IOP in adult patients with open-angle glaucoma.
Asunto(s)
Cirugía Filtrante/métodos , Glaucoma de Ángulo Abierto/cirugía , Implantación de Lentes Intraoculares , Facoemulsificación/métodos , Seudofaquia/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Catarata/complicaciones , Femenino , Glaucoma de Ángulo Abierto/complicaciones , Glaucoma de Ángulo Abierto/fisiopatología , Gonioscopía , Humanos , Presión Intraocular/fisiología , Limbo de la Córnea/cirugía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Tonometría Ocular , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To analyze the outcomes of surgery for dislocated intraocular lenses (IOLs) in patients with pseudoexfoliation (PXF). SETTING: Private practice, Boston, Massachusetts, USA. DESIGN: Retrospective case study. METHODS: Eyes with PXF and IOL dislocations that had IOL exchange or repositioning were reviewed. An outcomes analysis compared the surgical techniques with regard to corrected distance visual acuity (CDVA), intraocular pressure (IOP), and glaucoma medication requirements. RESULTS: The IOL exchange was performed in 64 eyes (79%) and IOL repositioning in 17 eyes (21%). The CDVA improved in all eyes, from a preoperative mean of 0.78 logMAR ± 0.50 (SD) to a mean of 0.35 ± 0.31 logMAR at the final follow-up (mean 2.5 ± 2.6 years) (P<.0001). The mean IOP was reduced by 4.2 mm Hg at the final follow-up (P<.0001). The mean glaucoma medication requirement remained stable at the final follow-up compared with the preoperative levels (P>.05). There were no significant differences in the mean CDVA, IOP, or glaucoma medication requirement between eyes that had IOL exchange and eyes that had IOL repositioning. There were no significant intraoperative complications. The most common postoperative complication was a transient decrease in IOP to 5 mm Hg or lower or an increase in IOP to 30 mm Hg or higher. CONCLUSIONS: Patients with PXF having surgical treatment of IOL dislocation have the potential for excellent visual outcomes with minimal intraoperative and postoperative complications. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
Asunto(s)
Migracion de Implante de Lente Artificial/cirugía , Síndrome de Exfoliación/complicaciones , Iris/cirugía , Implantación de Lentes Intraoculares , Esclerótica/cirugía , Técnicas de Sutura , Anciano de 80 o más Años , Migracion de Implante de Lente Artificial/etiología , Femenino , Humanos , Presión Intraocular/fisiología , Masculino , Reoperación , Estudios Retrospectivos , Colgajos Quirúrgicos , Resultado del Tratamiento , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To assess the short- and long-term effect of uneventful phacoemulsification, posterior chamber intraocular lens (IOL) implantation, and trabeculectomy on intraocular pressure (IOP) and glaucoma medication requirements in eyes with pseudoexfoliation glaucoma (PXG) and compare the results with those in eyes that had uneventful phacoemulsification only (reported in a previous study of the same cohort of pseudoexfoliation eyes). SETTING: Private practice, Boston, Massachusetts, USA. DESIGN: Comparative case series. METHODS: A retrospective analysis was performed of consecutive PXG eyes that had uneventful combined phacoemulsification and trabeculectomy by the same surgeon. The change in IOP, glaucoma medication requirements, and logMAR corrected distance visual acuity was compared between the combined surgery group and the phaco-alone group. RESULTS: The combined-surgery group (n = 138) had statistically significant reduced mean IOP and glaucoma medication requirements through 10 years postoperatively (P<.018). The change in IOP and glaucoma medication requirements was greater in the combined-surgery group than in the phaco-alone group (n = 240); this was statistically significant up to 7 years postoperatively (P<.022). The reduction in mean postoperative IOP was greater in eyes with a higher mean preoperative IOP. In the combined-surgery group, 13.8% of eyes required subsequent laser trabeculoplasty, glaucoma surgery, or both. CONCLUSIONS: Uneventful phacoemulsification, IOL implantation, and trabeculectomy resulted in significant long-term reduction in IOP and glaucoma medication requirements in eyes with PXG. Combined procedures resulted in greater and more longstanding reductions in IOP and glaucoma medication requirements and fewer 1-day postoperative IOP spikes than phacoemulsification alone. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
Asunto(s)
Síndrome de Exfoliación/cirugía , Glaucoma de Ángulo Abierto/cirugía , Implantación de Lentes Intraoculares , Facoemulsificación , Trabeculectomía , Anciano , Antihipertensivos/administración & dosificación , Catarata/complicaciones , Catarata/fisiopatología , Síndrome de Exfoliación/complicaciones , Síndrome de Exfoliación/fisiopatología , Femenino , Estudios de Seguimiento , Glaucoma de Ángulo Abierto/complicaciones , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Presión Intraocular/fisiología , Iridectomía , Terapia por Láser , Masculino , Estudios Retrospectivos , Tonometría Ocular , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To report 3-year results of the safety and efficacy of canaloplasty, a procedure involving circumferential viscodilation and tensioning of the inner wall of Schlemm canal to treat open-angle glaucoma. SETTING: Multicenter surgical sites. DESIGN: Nonrandomized multicenter clinical trial. METHODS: This study comprised adult open-angle glaucoma patients having canaloplasty or combined cataract-canaloplasty surgery. Qualifying preoperative intraocular pressures (IOPs) were at least 16 mm Hg with historical IOPs of at least 21 mm Hg. A flexible microcatheter was used to viscodilate the full circumference of the canal and to place a trabecular tensioning suture. Primary outcome measures included IOP, glaucoma medication use, and adverse events. RESULTS: Three years postoperatively, all study eyes (n = 157) had a mean IOP of 15.2 mm Hg ± 3.5 (SD) and mean glaucoma medication use of 0.8 ± 0.9 compared with a baseline IOP of 23.8 ± 5.0 mm Hg on 1.8 ± 0.9 medications. Eyes with combined cataract-canaloplasty surgery had a mean IOP of 13.6 ± 3.6 mm Hg on 0.3 ± 0.5 medications compared with a baseline IOP of 23.5 ± 5.2 mm Hg on 1.5 ± 1.0 medications. Intraocular pressure and medication use results in all eyes were significantly decreased from baseline at every time point (P<.001). Late postoperative complications included cataract (12.7%), transient IOP elevation (6.4%), and partial suture extrusion through the trabecular meshwork (0.6%). CONCLUSION: Canaloplasty led to a significant and sustained IOP reduction in adult patients with open-angle glaucoma and had an excellent short- and long-term postoperative safety profile. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.
Asunto(s)
Catéteres de Permanencia , Cirugía Filtrante/métodos , Glaucoma de Ángulo Abierto/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Antihipertensivos/administración & dosificación , Extracción de Catarata , Femenino , Humanos , Presión Intraocular , Complicaciones Intraoperatorias , Masculino , Microscopía Acústica , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Prospectivos , Resultado del Tratamiento , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To assess the frequency and results of cataract surgery with concurrent vitrectomy due to zonule weakness in eyes with pseudoexfoliation (PXF). SETTING: Private practice, Boston, Massachusetts, USA. METHODS: This retrospective nonrandomized study assessed consecutive eyes with PXF having cataract surgery. High risk was defined as preoperative phacodonesis, iridodonesis, or lens subluxation (subgroup 1); preoperative anterior chamber depth or angle-depth asymmetry between eyes confirmed by slitlamp biomicroscopy or gonioscopy, respectively (subgroup 2); or complicated cataract extraction related to zonule weakness in the fellow eye (subgroup 3). Exclusion criteria were previous vitrectomy, scleral buckle, or trabeculectomy surgery and combined cataract-glaucoma surgery. A comparative analysis of outcome parameters was performed. RESULTS: Of the 1059 eyes evaluated, 38 had vitrectomy. Concurrent vitrectomy was required in 19 (15.6%) of 122 high-risk eyes and 19 (2.0%) of 937 non-high-risk eyes (P<.00001). The need for concurrent vitrectomy was greatest in subgroup 3 (72.7%) and subgroup 1 (42.9%). There was no statistically significant difference between the vitrectomy group and the no-vitrectomy group in the mean improvement in logMAR corrected distance visual acuity (CDVA) (P = .38) or mean change in intraocular pressure (IOP) (mean decrease 2.6 mm Hg +/- 1.5 [SD] and 1.6 +/- 0.5 mm Hg, respectively) (P = .47). CONCLUSION: Despite the need for vitrectomy and the attendant increased demands in postoperative care, both the vitrectomy group and no-vitrectomy group had improved logMAR CDVA and IOP. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
Asunto(s)
Síndrome de Exfoliación/complicaciones , Ligamentos/patología , Facoemulsificación , Vitrectomía , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Presión Intraocular/fisiología , Complicaciones Intraoperatorias , Masculino , Complicaciones Posoperatorias , Estudios Retrospectivos , Factores de Riesgo , Agudeza Visual/fisiologíaRESUMEN
As the rate of terrorism increases, it is important for health care providers to become familiar with the management of injuries inflicted by blasts and explosions. This article reviews the ocular injuries associated with explosive blasts, providing basic concepts with which to approach the blast-injured patient with eye trauma. We conducted a literature review of relevant articles indexed in PubMed between 1948 and 2007. Two hundred forty-four articles were reviewed. We concluded that ocular injury is a frequent cause of morbidity in blast victims, occurring in up to 28% of blast survivors. Secondary blast injuries, resulting from flying fragments and debris, cause the majority of eye injuries among blast victims. The most common blast eye injuries include corneal abrasions and foreign bodies, eyelid lacerations, open globe injuries, and intraocular foreign bodies. Injuries to the periorbital area can be a source of significant morbidity, and ocular blast injuries have the potential to result in severe vision loss.
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Traumatismos por Explosión/diagnóstico , Traumatismos por Explosión/terapia , Auxiliares de Urgencia , Medicina de Emergencia/métodos , Lesiones Oculares/etiología , Trastornos de la Visión/etiología , Traumatismos por Explosión/complicaciones , Explosiones , Lesiones Oculares/diagnóstico , Lesiones Oculares/terapia , Humanos , Terrorismo , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/prevención & control , Trastornos de la Visión/terapiaRESUMEN
This review provides a comprehensive assessment of intraocular pressure (IOP), phacoemulsification techniques, and intraocular lenses (IOLs) in pseudoexfoliation (PXF) eyes having cataract surgery. Pseudoexfoliation is ubiquitous and the most common cause for open-angle glaucoma worldwide. Cataracts occur with increased frequency in PXF eyes, and surgery is potentially complicated by the presence of small pupils and zonule laxity and significantly affects IOP in these eyes. Preoperative evaluation and the options for intraoperative management of cataract are presented with recommendations for the use of adjunctive pupil and zonule support devices. Postoperative complications such as capsule contraction and IOL instability are discussed and laser and surgical options to manage these special problems presented.
Asunto(s)
Catarata/complicaciones , Síndrome de Exfoliación/complicaciones , Presión Intraocular/fisiología , Complicaciones Intraoperatorias , Lentes Intraoculares , Facoemulsificación/métodos , Complicaciones Posoperatorias , Catarata/terapia , Glaucoma de Ángulo Abierto/etiología , Humanos , Implantación de Lentes Intraoculares , Cuidados Preoperatorios , Factores de RiesgoRESUMEN
PURPOSE: To evaluate 2-year postsurgical safety and efficacy of canaloplasty (circumferential viscodilation and tensioning of the inner wall of Schlemm canal) to treat open-angle glaucoma (OAG). SETTING: Multicenter surgical sites. METHODS: This international prospective study comprised adult OAG patients having glaucoma surgery or combined glaucoma-cataract surgery. Qualifying preoperative intraocular pressure (IOP) was at least 16 mm Hg and historical IOP, at least 21 mm Hg. The full circumference of the canal was viscodilated and a trabecular tensioning suture placed with a microcatheter. Primary outcome measures included IOP and glaucoma medication use. RESULTS: At 24 months, all 127 eyes (127 patients) had a mean IOP of 16.0 mm Hg +/- 4.2 (SD) and mean glaucoma medication use of 0.5 +/- 0.8 (baseline values 23.6 +/- 4.8 mm Hg and 1.9 +/- 0.8 medications). Eyes with canaloplasty alone had a mean IOP of 16.3 +/- 3.7 mm Hg and 0.6 +/- 0.8 medications (baseline values 23.2 +/- 4.0 mm Hg and 2.0 +/- 0.8 medications). Eyes with combined glaucoma-cataract surgery had a mean IOP of 13.4 +/- 4.0 mm Hg and 0.2 +/- 0.4 medications (baseline values 23.1 +/- 5.5 mm Hg and 1.7 +/- 1.0 medications). The IOP and medication use results at all time points were statistically significant versus baseline (P <.001). The late postoperative follow-up identified 3 patients with elevated IOP. No other serious ocular or nonocular complications were reported. CONCLUSION: Canaloplasty was safe and effective in reducing IOP in adult patients with OAG.
Asunto(s)
Segmento Anterior del Ojo/cirugía , Cirugía Filtrante/métodos , Glaucoma de Ángulo Abierto/cirugía , Ácido Hialurónico/administración & dosificación , Técnicas de Sutura , Viscosuplementos/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Segmento Anterior del Ojo/diagnóstico por imagen , Cateterismo , Femenino , Gonioscopía , Humanos , Presión Intraocular , Masculino , Microscopía Acústica , Persona de Mediana Edad , Polipropilenos , Estudios Prospectivos , Suturas , Resultado del Tratamiento , Agudeza VisualRESUMEN
PURPOSE: To assess the effect of phacoemulsification with posterior chamber intraocular lens (IOL) implantation performed by a single surgeon on intraocular pressure (IOP) and glaucoma medication requirements in pseudoexfoliation (PFX) eyes with or without glaucoma. SETTING: Private practice, Boston, Massachusetts, USA. METHODS: This retrospective analysis comprised 1122 eyes with PFX having uneventful phacoemulsification with IOL implantation. Of the eyes, 882 did not have glaucoma (PFX group) and 240 had glaucoma (PXG group). A comparative outcomes analysis was performed; the analysis focused on IOP and change in glaucoma medication requirements between the 2 groups. RESULTS: The mean IOP was statistically significantly reduced through 7 years postoperatively compared with preoperatively in the PFX group. The PXG group had reduced mean IOP for 1 year and reduced glaucoma medication requirements at almost all postoperative time intervals. Higher mean preoperative IOP was associated with a greater reduction in mean IOP postoperatively in both groups. Intraocular pressure spikes (> 30 mm Hg) 1 day postoperatively occurred in 4% in the PFX group and 17% in the PXG group. Postoperatively, 2.7% of PFX eyes progressed to a need for glaucoma medication and 3.7% of PXG eyes progressed to a need for laser and/or glaucoma surgery. CONCLUSIONS: A long-term reduction in mean IOP occurred in PFX eyes with and without glaucoma. The IOP reduction was proportional to the preoperative IOP; higher preoperative IOP was associated with a greater reduction in IOP. Glaucoma progression in both groups was low, suggesting a protective effect of phacoemulsification on IOP in these eyes.
Asunto(s)
Síndrome de Exfoliación/complicaciones , Glaucoma de Ángulo Abierto/prevención & control , Presión Intraocular , Implantación de Lentes Intraoculares , Facoemulsificación , Anciano , Progresión de la Enfermedad , Femenino , Glaucoma de Ángulo Abierto/etiología , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Masculino , Estudios Retrospectivos , Tonometría Ocular , Agudeza VisualRESUMEN
PURPOSE: To compare intraoperative and postoperative complications, best corrected visual acuity, intraocular pressure (IOP), and glaucoma medication requirements between eyes with clinically apparent pseudoexfoliation (PEX) and fellow eyes without PEX in patients having bilateral cataract surgery. SETTING: Private practice, Boston, Massachusetts, USA. METHODS: This retrospective study comprised 1000 consecutive patients who had cataract surgery performed by the same surgeon. Of the 1000 patients, 137 had unilateral PEX and bilateral cataract surgery. Patients with previous or concurrent glaucoma surgery were eliminated from the study. Two-way analysis of variance and Tukey post hoc tests were used for statistical analysis. RESULTS: Complications were few, with no significant differences between the 2 groups intraoperatively (zonule instability) or postoperatively (corneal edema, cystoid macular edema, intraocular lens decentration). Both groups had improved visual acuity, with no statistically significant between- group difference in acuity at 1 year. Both groups had decreased IOP postoperatively, although the eyes with PEX had a significantly greater mean Delta IOP than the fellow eyes without PEX (P<.016). The PEX group required more glaucoma medications overall (P<.003) and needed more glaucoma medications at 3 to 5 years than preoperatively; the medication requirement in the fellow-eye group remained stable. CONCLUSIONS: The presence of clinically apparent PEX had an impact on IOP reduction and glaucoma medication requirements. There were no differences in intraoperative or postoperative complications between eyes with PEX and fellow eyes without PEX.
Asunto(s)
Síndrome de Exfoliación/complicaciones , Presión Intraocular/fisiología , Complicaciones Intraoperatorias , Implantación de Lentes Intraoculares , Facoemulsificación , Complicaciones Posoperatorias , Agudeza Visual/fisiología , Anciano , Antihipertensivos/administración & dosificación , Catarata/complicaciones , Femenino , Glaucoma de Ángulo Abierto/tratamiento farmacológico , Glaucoma de Ángulo Abierto/etiología , Humanos , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: To determine the incidence of hypotony and intraocular pressure (IOP) elevation in the immediate and early postoperative period after temporal posterior limbal phacoemulsification and intraocular lens (IOL) implantation. SETTING: Ambulatory surgical center. METHODS: This prospective analysis comprised 310 eyes that had temporal posterior limbal phacoemulsification with IOL implantation. Surgical parameters included keratome incision of 2.85 mm, incision length of 2.5 mm, peribulbar anesthesia, case-completion IOP of 20 mm Hg, and postoperative lid taping. The IOP measurements were collected preoperatively and 30 minutes and 1 day after surgery. RESULTS: Nineteen eyes (6.1%) had an IOP lower than 5 mm Hg 30 minutes postoperatively in the absence of incision leakage at the paracentesis or keratome sites. Eighteen of the 19 eyes with postoperative hypotony received hydroxypropyl methylcellulose 2% (OcuCoat) and 1 received hypromellose 2% (Cellugel). None of the 23 eyes with an acrylic IOL implanted via a cylindrical lens inserter had an IOP lower than 5 mm Hg postoperatively. Suturing did not significantly affect the incidence of hypotony, and there were no postoperative complications related to hypotony. The mean IOP at 30 minutes was lower than at 1 day in the normal, glaucoma, and glaucoma-suspect groups. Twenty-one normal eyes (8.1%), 5 glaucoma eyes (15.6%), and 1 glaucoma-suspect eye (5%) had an IOP greater than 30 mm Hg 1 day postoperatively. CONCLUSIONS: Postoperative hypotony (IOP <5 mm Hg) occurred in 19 (6.1%) of 310 eyes. At 1 day, IOP higher than 30 mm Hg was more frequent in glaucoma eyes than in normal eyes. Although there were no direct problems related to hypotony at 30 minutes or to elevated IOP (>30 mm Hg) at 1 day, surgeons should be aware of and check for IOP variability (low and high) that can occur in normal, glaucoma, and glaucoma-suspect eyes within the first 24 hours after surgery.
Asunto(s)
Glaucoma de Ángulo Abierto/complicaciones , Presión Intraocular/fisiología , Implantación de Lentes Intraoculares , Facoemulsificación , Periodo Posoperatorio , Anciano , Catarata/complicaciones , Femenino , Humanos , Incidencia , Masculino , Hipertensión Ocular/complicaciones , Estudios Prospectivos , Tonometría OcularRESUMEN
PURPOSE: This study evaluates the change in intraocular pressure (IOP) and glaucoma medication requirements after clear corneal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and normal patients at 3 years and last follow-up (mean 5 y). PATIENTS AND METHODS: This study represents a retrospective analysis of patients who had clear corneal phacoemulsification and at least 3 years of follow-up. The patients were classified into 3 groups: glaucoma (G), glaucoma suspects (GS), and no glaucoma (NG). No patient had a history of previous intraocular surgery. Single factor analysis of variance, Fisher exact tests, 2-tailed paired Student t tests and Kaplan-Meier analysis were applied. RESULTS: Forty-eight patients (55 eyes) in the glaucoma group, 41 patients (44 eyes) in the GS group, and 59 patients (59 eyes) in the NG group met the above criteria. At 3 years follow-up IOP was significantly decreased in all groups; (G) group decreased 1.4+/-3.3 mm Hg (P = 0.0025), GS 1.4+/-4.2 mm Hg (P = 0.004), and NG 1.7+/-3.1 mm Hg (P = 0.0005). At the final follow-up visit (mean near 5 y for all groups) the IOP was significantly decreased in all groups, (G) group 1.8+/-3.5 mm Hg (P = 0.005), GS 1.3+/-3.7 mm Hg (P = 0.025), and NG 1.5+/-2.5 mm Hg (P < 0.0001). The number of preoperative and postoperative glaucoma medications in the (G) group did not show any significant change at 3 and 5 years (P = 0.36, P = 0.87). Kaplan-Meier analysis shows that at 3 years, 85% of the (G) group, 81% of GS, and 90% of the NG had IOPs less than or equal to their preoperative IOP, with the same number of glaucoma medications or less. At 5 years the percentages were 76%, 79%, and 85%, respectively. CONCLUSIONS: This study demonstrates that cataract removal by clear cornea phacoemulsification in glaucoma patients, glaucoma suspects, and normal patients results in a small but significant decrease in IOP that is sustained at 3 years and a mean of 5 years in all groups. This study does not imply that cataract removal by phacoemulsification is a substitute for a combined procedure but may be an appropriate procedure for certain patients based on medication requirements and extent of optic nerve damage.
Asunto(s)
Catarata/fisiopatología , Córnea/cirugía , Glaucoma de Ángulo Abierto/fisiopatología , Presión Intraocular/fisiología , Facoemulsificación/métodos , Anciano , Antihipertensivos/uso terapéutico , Catarata/terapia , Femenino , Estudios de Seguimiento , Glaucoma de Ángulo Abierto/tratamiento farmacológico , Humanos , Masculino , Hipertensión Ocular/tratamiento farmacológico , Hipertensión Ocular/fisiopatología , Estudios RetrospectivosRESUMEN
PURPOSE: To determine whether pupil stretch during phacoemulsification affects postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), and inflammation compared with results in patients without pupil stretch. METHODS: A retrospective analysis of 115 eyes that had pupil stretch during phacoemulsification (study group) and 125 eyes without pupil stretch (control group) was performed with a minimum of 12 months follow-up. Single-factor analysis of variance and 2-tailed homoscedastic t tests were used for statistical analysis. RESULTS: The mean preoperative logMAR equivalent BCVA was 0.5 +/- 0.3 (SD) in the study group and 0.6 +/- 0.4 in the control group. The mean preoperative IOP was 16.2 +/- 4.1 mm Hg in the study group and 16.0 +/- 3.5 mm Hg (control group). There was no statistically significant difference at postoperative follow-up of 1 year in BCVA or IOP between the 2 groups (1 year BCVA 0.2 +/- 0.2 [study group], 0.2 +/- 0.2 [control group] [P<.1]; IOP 14.5 +/- 3.5 mm Hg and 14.7 +/- 3.3 mm Hg, respectively [P<.7]). There was no significant difference in the number of glaucoma medications required for glaucoma patients preoperatively and postoperatively between the 2 groups (P<.5). Complications were rare, and there was no significant difference in the complications (ie, iritis, hyphema, cystoid macular edema, epiretinal membrane formation) between the 2 groups at 1 year. CONCLUSION: Pupil stretch during phacoemulsification was not associated with a statistically significant difference in BCVA, IOP, inflammation, or other complications postoperatively compared with results in the control group without pupil stretch.
Asunto(s)
Presión Intraocular/fisiología , Iritis/fisiopatología , Facoemulsificación , Pupila/fisiología , Expansión de Tejido , Agudeza Visual/fisiología , Antihipertensivos/administración & dosificación , Humanos , Inflamación/fisiopatología , Iris/fisiología , Implantación de Lentes Intraoculares , Periodo Posoperatorio , Estudios Retrospectivos , Tonometría OcularRESUMEN
PURPOSE: To compare the results of 1-site versus 2-site combination glaucoma filtration and phacoemulsification surgery with respect to visual acuity, intraocular pressure (IOP), and glaucoma medication requirements via a case control study. METHODS: Results of 2-site phacotrabeculectomy surgery in 64 eyes of 59 patients were retrospectively reviewed with a minimum follow-up of 1 year. The 2-site procedures were compared with a randomly chosen control group of 71 1-site phacotrabeculectomies performed by the same surgeon. RESULTS: The presurgical visual acuity, IOP, and glaucoma medication requirements did not differ significantly between the 2 groups. Mean final postoperative results at 1 year for 2-site versus 1-site eyes, respectively, were visual acuity 0.32 +/- 0.353 (SD) and 0.32 +/- 0.37 (P = .99), IOP 15.0 +/- 3.7 mm Hg and 15.1 +/- 6.3 mm Hg (P = .97), and glaucoma medication requirements 0.43 +/- 0.90 and 0.61 +/- 1.1 (P = .52). CONCLUSION: There was no statistically significant difference in the final visual acuity, IOP, or glaucoma medication requirements between the 2-site and 1-site groups.
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Antihipertensivos/administración & dosificación , Presión Intraocular/fisiología , Facoemulsificación/métodos , Trabeculectomía/métodos , Agudeza Visual/fisiología , Estudios de Casos y Controles , Catarata/complicaciones , Catarata/terapia , Fluorouracilo/administración & dosificación , Estudios de Seguimiento , Glaucoma/complicaciones , Glaucoma/cirugía , Humanos , Presión Intraocular/efectos de los fármacos , Complicaciones Intraoperatorias , Implantación de Lentes Intraoculares/métodos , Mitomicina/administración & dosificación , Complicaciones Posoperatorias , Pronóstico , Estudios Retrospectivos , Tonometría OcularRESUMEN
PURPOSE: To analyze the intraocular pressure (IOP), glaucoma medication requirements, and visual acuity after glaucoma filtration surgery in pseudophakic eyes. SETTING: Private practice, Boston, Massachusetts, USA. METHODS: The results of glaucoma filtration surgery in 47 eyes of 40 pseudophakic patients with a minimum follow-up of 1 year were retrospectively reviewed. Eyes with previously surgically manipulated conjunctiva in the area of filtration were compared to eyes without previous manipulation. RESULTS: Preoperatively, the mean IOP was 25 mm Hg +/- 7.3 (SD); mean number of glaucoma medications, 3.3 +/- 1.0; and mean logMAR visual acuity, 0.41 +/- 0.38. At the final follow-up visit (mean 36.5 +/- 31.5 months), the respective means were 13.6 +/- 6.6 mm Hg (P<.001), 0.9 +/- 1.4 (P<.001), and 0.46 +/- 0.43 (P=.53). The mean postoperative IOP, glaucoma medication requirements, and visual acuity at the final follow-up in eyes with virgin conjunctiva and eyes with previously manipulated conjunctiva were, respectively, as follows: IOP, 12.5 +/- 3.2 mm Hg and 14.1 +/- 7.6 mm Hg (P=.52); medications, 1.1 +/- 1.3 and 0.9 +/- 1.4 (P=.66); and logMAR acuity, 0.6 +/- 0.52 and 0.4 +/- 0.39 (P=.23). CONCLUSIONS: Glaucoma filtration surgery in pseudophakic eyes significantly improved IOP and reduced glaucoma medication requirements while maintaining stability of vision. There were no statistically significant differences in final IOP, glaucoma medication requirements, or visual acuity between eyes with virgin conjunctiva and eyes with previously surgically manipulated conjunctiva.
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Cicatriz/patología , Conjuntiva/patología , Glaucoma de Ángulo Abierto/cirugía , Seudofaquia/cirugía , Trabeculectomía , Anciano , Antihipertensivos/uso terapéutico , Conjuntiva/cirugía , Femenino , Estudios de Seguimiento , Humanos , Presión Intraocular/fisiología , Implantación de Lentes Intraoculares , Masculino , Facoemulsificación , Estudios Retrospectivos , Resultado del Tratamiento , Agudeza Visual/fisiologíaRESUMEN
UNLABELLED: To characterize the differences in technique, complications, and outcomes in a large series of cataract extractions in patients with and without pseudoexfoliation (PEX) syndrome. SETTING: Ophthalmic Consultants of Boston, Boston, Massachusetts, USA. METHODS: A retrospective analysis was performed of 297 cases of cataract extraction in patients with PEX and 427 cases of cataract extraction in patients without PEX. This study examined and quantified the intraoperative and postoperative complications, performed a comparative outcomes analysis of intraocular pressure (IOP) change, and determined the prevalence of systemic vascular diseases in these patients. RESULTS: The overall rate of vitreous loss was 4% (7/297) in the PEX population and 0% (0/427) in the non-PEX group. There were no overall differences in the rate of postoperative complications. At 2 years, IOP had declined from a mean of 16.8 to 13.9 mm Hg in the PEX group and from 16.3 to 14.4 mm Hg in the non-PEX group. The decline was significantly greater in the PEX group. The prevalence of hypertension and diabetes was significantly greater in the non-PEX group (50% and 11%, respectively) than in the PEX group (38% and 5%, respectively). CONCLUSIONS: The increased frequency of intraoperative complications during cataract extraction in PEX patients stemmed from zonular weakness rather than capsule tears. Postoperative IOP declines were greater in the PEX group even 2 years after cataract extraction, suggesting the potential for long-term improvement in outflow facility in patients with coexisting cataract and glaucoma.
Asunto(s)
Catarata/terapia , Síndrome de Exfoliación/cirugía , Glaucoma/cirugía , Complicaciones Intraoperatorias , Facoemulsificación/métodos , Complicaciones Posoperatorias , Anciano , Catarata/complicaciones , Síndrome de Exfoliación/complicaciones , Femenino , Glaucoma/complicaciones , Humanos , Implantación de Lentes Intraoculares/métodos , Masculino , Estudios Retrospectivos , Trabeculectomía/métodos , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the intraocular pressure (IOP), best corrected visual acuity (BCVA), and glaucoma medication requirements in patients having phacoemulsification after preexisting glaucoma filters. SETTING: Ophthalmic Consultants of Boston, Boston, Massachusetts, USA. METHODS: A retrospective analysis of 58 eyes that had temporal phacoemulsification via a clear corneal (32 eyes) or a scleral tunnel (26 eyes) approach after filtration surgery was performed with a minimum follow-up of 12 months. Two-tailed homoscedastic t tests were used for statistical analysis. RESULTS: The mean preoperative IOP in all eyes was 11.8 mm Hg +/- 4.2 (SD), and the mean final postoperative IOP was 13.7 +/- 4.6 mm Hg (P<.022). The mean preoperative logMAR equivalent BCVA was 0.8 +/- 0.4, which improved to a mean of 0.4 +/- 0.4 postoperatively (P<.0000002). There was no statistically significant change in glaucoma medication requirements postoperatively. The differences in IOP, BCVA, and postoperative glaucoma medication requirements were not statistically significant between the clear corneal group and the scleral tunnel group or between patients who received mitomycin at the time of filtration surgery and those who did not. There were no intraoperative complications; 1 patient required additional glaucoma surgery. CONCLUSION: Clear corneal or scleral tunnel phacoemulsification in the setting of a preexisting glaucoma filter was associated with improved BCVA, a small but statistically significant increase in IOP, and stability in the number of glaucoma medicines required for IOP control over a minimum follow-up of 1 year.