Svetlana Anisimova
Eye Center, Russia
Title: Combined non-penetrating deep sclerectomy with xenoplast drainage and femtoassisted phacoemulsification in patients with cataract and glaucoma
Biography
Biography: Svetlana Anisimova
Abstract
Background: The problem of cataract treatment in patients with coexisting glaucoma attracts attention of ophthalmologists for many years. Most of them prefer combined surgery in these cases because both intraocular pressure (IOP) can be normalized and visual acuity can be improved. But at the same time this kind of surgery is a more difficult procedure, because of specific changes of glaucoma eye. Non-penetrating deep sclerectomy (NPDS) has less complications and is more adapted for this combined surgery. The presence of trabecular-Descemet’s membrane during NPDS can provide anterior chamber stability and increase the safety of phacoemulsification. The first experience of femtosecond laser assistance in cataract surgery proved that it can decrease the trauma of phacoemulsification, because of less mechanical strength on lens zonullar. This is very actual in eyes with glaucoma because of dystrophic changes leading to pseudo-exfoliation syndrome and lens subluxation.
Aim: The purpose of this work was to evaluate the effectiveness and safety of femto assisted phacoemulsification with NPDS in cases of glaucoma and cataract combination
Materials & Methods: All the patients were divided into groups according to the procedure performed: Phacoemulsification- 269 eyes; femto assisted phacoemulsification- 461 eye; phacoemulsification with NPDS; xenoplast drainage implantation- 11 eyes; femto assisted phacoemulsification with NPDS and; xenoplast drainage implantation- 53 eyes. Before and after the surgery, the standard ophthalmology examinations were performed. Besides this OCT (if it was possible according to ophthalmoscopy) and ORA examinations were performed. Intraoperative IOP evaluation was performed manually with Tono-pen. According to ESCRS recommendation, all patients before the operation received antibiotics, non-steroid antibiotics, ICA and mydriatics. Phacoemulsification was performed on Stellaris PC, and femto laser assistance (capsulorhexis, fragmentation and incisions) on Victus femtosecond laser. Intraocular lens implanted were en-Vista, Technis, AcryStyle and Hoya. Postoperatively all patients received combined steroid and antibiotic drops, non-steroids and kerato-protectors. As hypotensive medication in treating of postoperative hypertension in all cases, ICA was used.
Results: Vision acuity before operation in average was: One group- 0.13; two group- 0.23; three group- 0.24 and; four group- 0.14. One month after operation, it was 0.67; 0.72; 0.66 and 0.68 correspondingly. There was no difference between IOP levels in first two groups one day after the surgery was, so adding femto laser assistance to standard phacoemulsification procedure didn't change IOP level in early postop period. Femto laser assistance in all cases decreased the intraocular working time. During standard combined procedure, it was from 24 to 35 minutes, and with femto-laser assistance it reduced to 16-22 minutes. There were no cases of hemorrhage intraoperative complications. In groups of combined surgery IOP normalized by 5-10 days after the surgery. At IOP level of 17-20 or in cases of far advanced glaucoma, all patients constantly received hypotensive instillations medication. Xenoplast drainage never gives any inflammatory reaction or in-capsulation. IAG-laser goniopuncture was effective 2-12 months after surgery.
Conclusions: Combined phacoemulsification and NPDS with xenoplast drainage implantation is safe and effective procedure for combined treatment of cataract and glaucoma. Femto assistance in cataract surgery is a safe procedure which reduces the intraocular operation time and doesn't lead to intraoperative and postoperative complications increase.