Posters

The results of combined surgical treatment of refractory glaucoma and complicated cataract

Poster Details

First Author: A. Kulikov RUSSIAN FEDERATION

Co Author(s):    A. Kowalskaya   S. Sosnowskiy   N. Haritonova   O. Butikova           

Abstract Details

Purpose:

To evaluate the results of combined phacosurgery with Ex-press shunt implantation in patients with refractory glaucoma and complicated cataract.

Setting:

Department of ophthalmology, Medical Military Academy, Saint-Petersburg, Russia

Methods:

We observed 24 consecutive patients (24 eyes), mean age 72.3 years. All patients had primary cataract and refractory previously operated advanced (stage III) glaucoma and preoperative intraocular pressure (IOP) over the level of tolerance at a maximum IOP-reducing drop therapy. All patients underwent combined surgery – phacoemulsification and Ex-press shunt implantation. Standard glaucomous examinations (visual acuity (VA), visual field defects, IOP) were recorded at baseline, then 1, 2, 3 months postoperatively and then quarterly. Any postoperative complications were also recorded in early postop. In addition, postoperatively the requirement for IOP-reducing medications was estimated. The follow-up was 3-24 months.

Results:

Baseline VA was 0.47±0.31, postop VA was 0.62±0.27 and remained constant over the entire follow-up. Baseline IOP was 29.3±8.6 mmHg. In the early postop mean IOP was 16.1±2.7 mmHg. 6 months postoperatively IOP increased in 7 eyes up to 24 mmHg, 9 months postoperatively IOP increased in 2 eyes up to 26 mmHg, up to 36 mmHg in 1 eye. All those were prescribed antihypertensive therapy. In early postoperative period we observed hyphema in 1 eye (4.2%), choroidal detachment in 7 eyes (29.2%). All complications were completely cured by drug therapy or minimally invasive surgical procedures.

Conclusions:

The application of combined surgery allows to achieve a statistically significant improvement of VA due to phacoemulsification with IOL implantation and stabilization of glaucoma, normalization of IOP due to Ex-press glaucoma drainage within the first 6 months after treatment. In a more long-term postop period it is necessary to use antihypertensive drugs (41.7 % of patients) or repeated antiglaucomatous surgical procedures (8 % of patients).

Financial Disclosure:

NONE