Choice of surgery in cases of primary angle-closure glaucoma complicated pseudoexfoliative syndrome

Session Details

Session Title: Glaucoma II

Session Date/Time: Monday 15/09/2014 | 08:00-10:30

Paper Time: 08:00

Venue: Boulevard F (Level 1)

First Author: : E.Egorova RUSSIA

Co Author(s): :    U. Fayzieva   D. Yusupova           

Abstract Details

Purpose:

To determine the indications for phacoemulsification and to estimate its results in cases of primary angle closure glaucoma (PACG), complicated with pseudoexfoliative syndrome (PES).

Setting:

The S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia. The Eye Clinic at the Ministry of Heath of the Republic of Uzbekistan.

Methods:

For this investigation 122 Uzbek patients (200 eyes) with hyperopic type of eyes (axial length was 22.5mm and less) have been selected. The main group included 86 patients (137 eyes) with PACG and different degrees of lens opacity. The comparative group included 36 patients (63 eyes) without glaucoma and with transparent lens. The average age was not statistically significant in two groups and was 54.8±1.6 and 56.4±1.3 years, respectively. Parameters of iridocilliary structures and area, volume, configuration of posterior chambers were measured by the UBM, model 840 (Zeiss-Humphrey Instruments). The UBM examination was carried out before laser peripheral iridectomy, 2 days after the laser intervention and 2 weeks after phacoemulsification. All eyes had undergone laser peripheral iridotomy 1-2 days before cataract surgery. Phacoemulsification was performed through clear corneal incision with in-the capsular bag implantation of foldable IOL (Acrysof IQ, Alcon Laboratories).

Results:

PES was found only 11.2% clinically. The presence of flakes of pseudoexfoliative material was revealed on iridocilliary structures in all patients with PACG by means UBM. Difference of cilliary zonule fibers length differed by 0.2-0.7mm in various segments. The asymmetry of iridocilliary structures parameters and disturbance of their topographic relationships have been found by UBM in cases of PES with zonules damage and lead to a combination of eye blocks in one eye in these cases. In segments of cilliary zonule fibers stretching (0.68±0.02mm) the UBM reflected a picture of relative pupillary block. In opposite segment a sharp reduction of visualized cilliary zonule fibers (0.27±0.02mm) was revealed and UBM reflected a picture of plateau iris syndrome. Laser iridectomy eliminated only pupillary block with segmental opening of anterior chamber angle and created optimal conditions for phacoemulsification by IOP lowering (3.5+1.9mmHg). Subsequent phacoemulsiaicftion decreased the IOP from an average preoperative level by 13.5±2.7mmHg. Visual acuity improves up to 0.7-1.0 in 84.5% cases. Phacoemulsiaicftion eliminated combination of eye blocks complicated by PES restoring anatomic topographic relationships of structures of iridocilliary zone in all cases.

Conclusions:

UBM allowed to diagnose PES in cases of PACG independently of presence clinical symptoms. PES was accompanied by alterations of topographic relationships of iridocilliary zonule structures due to zonule system weakness. In these situations an appearance of intraocular blocks combination is possible: pupillary block, block induced by lens and block of plateau iris syndrome that requires differentially treatment of PACG. Laser peripheral iridotomy is a base operation in PACG cases with pupillary block. But sometimes its effect is short or may absent due to another mechanisms of anterior chamber block – namely a block induced lens or plateau iris syndrome. Only segmental opening of anterior chamber angle with short-term hypotensive effect was noted in 34.2% cases. Laser iridotomy in cases of eye blocks combination of in one eye created optimal conditions for lens phacoemulsification by segmental opening of the anterior chamber angle and decreasing IOP from preoperative level. Lens phacoemulsification with foldable IOL implantation is pathogenic operation in cases of eye blocks combinations in patients with PACG complicated PES. Phacoemulsiaicftion allowed to decrease of intraocular pressure, to achieve of its stability and to restore anatomic topographic relationships of iridocilliary zone.

Financial Interest:

NONE