Combined non-perforating deep sclerotomy and femto-assisted phacoemulsification in patients with cataract and glaucoma

Session Details

Session Title: Femtocataract I

Session Date/Time: Sunday 14/09/2014 | 08:00-10:00

Paper Time: 09:48

Venue: Boulevard A

First Author: : S.Anisimova RUSSIA

Co Author(s): :    S. Anisimov   I. Novak   L. Arutyunyan   N. Chigovanina   L. Zagrebelnaya   K. Polyakova

Abstract Details

Purpose:

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 sclerotomy (NPDS) has less complications and is more adapted for this combined surgery. The presence of trabecular-descemet 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 zonulla. This is very actual in eyes with glaucoma because of dystrophic changes leading to lens subluxation. The purpose of this work was to evaluate the effectiveness and safety of femtoassisted phacoemulsification with NPDS in cases of glaucoma and cataract combination

Setting:

Eye Center 'East sight recovery'

Methods:

All the patients were divided to groups according to the procedure performed: 1. Phacoemulsification -269 eyes 2. Femtoassisted phacoemulsification- 461 eye 3. Phacoemulsification with NPDS and Xenoplast drainage implantation - 11 eyes 4. Femtoassisted 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 ophthalmoscopy) and ORA examinations were performed. Intraoperative IOP evaluation was performed manually with Tonopen. According to ESCRS recommendation all patients before the operation received antibiotics, non-steroid anti inflammatory drops and mydriatics. Phacoemulsification was performed on Stellaris PC, and femtolaser assistance (capsulorhexis, fragmentation and incisions) on Victus femtosecond laser. Intraocular lens implanted were AcrySof, En-Vista, AcryStyle and Hoya. Postoperatively all patients received combined steroid and antibiotic drops, non-steroid antiinflammatory drops and keratoprotectors. As hypotensive medication in treating of postoperative hypertension in all cases carboangidraze inhibitors were used.

Results:

Vision acuity before operation in average was: 1 group- 0.13; 2 group- 0.23; 3 group- 0.24; 4 - 0.14. 1 months 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 1 day after the surgery was, so adding femtolaser assistance to standard phacoemulsification procedure didn't change IOP level in early postop period. Femtolaser assistance in all cases decreased the intraocular working time. During standard combined procedure it was from 24 to 35 minutes, and with femtolaser 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 day after the surgery. At IOP level of 17-20 or in cases of far advanced glaucoma all patients constantly received hypotensive instillations medication

Conclusions:

Combined phacoemulsification and NPDS with Xenoplast implantation is safe and effective procedure for combined treatment of cataract and glaucoma combination in outpatient conditions. Femtoassistance in cataract surgery is a safe procedure which reduces the intraocular operation time and doesn't lead to intraoperative and postoperative complications increase.

Financial Interest:

NONE