Complex use of energetic surgery in treatment of patients with primary open-angle glaucoma and cataract on the background of pseudoexfoliative syndrome

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Abstract

BACKGROUND: Glaucoma remains one of the current problems of modern ophthalmology. The combination of glaucoma and cataract is observed in 17–38.6% of cases, and glaucoma with pseudoexfoliative syndrome – in 20–50% of primary open-angle glaucoma cases.

AIM: The aim of this work is to develop an effective and safe technology of complex energetic surgical treatment of the incipient primary open-angle glaucoma stage and cataract on the background of pseudoexfoliation syndrome on the basis of modified laser, hydrodynamic and ultrasound methods’ use.

MATERIALS AND METHODS: 187 patients (187 eyes) with the incipient stage of primary open-angle glaucoma, cataract and pseudoexfoliation syndrome were examined. In the main group (111 eyes), selective laser trabeculoplasty followed by femtosecond laser-assisted cataract surgery with hydrodynamic trabeculocleaning was performed. Patients in the control group (76 eyes), after selective laser trabeculoplasty, underwent phacoemulsification according to the standard technique.

RESULTS: The developed technology allowed to reach the hypotensive effect in 35.2% (t=23.0; р < 0.001) of baseline intraocular pressure values, of individual intraocular pressure level without adding IOP-lowering medications in 27% of cases, stabilization of visual functions and morphometric indices of the optic disc during 2 years of follow-up in 97.3% of cases unlike the selective laser trabeculoplasty with subsequent phacoemulsification (21.2, 5.3 and 81.6% respectively). The patients of the main group had significantly lower energy expenditure during the stage of phacoemulsification, a lower percentage of postoperative inflammatory reaction was noted, and a persistent hypotensive effect with stabilization of visual functions was achieved based on the results of a two-year follow-up.

CONCLUSIONS: Femtosecond laser-assisted phacoemulsification, performed as part of complex treatment in patients with cataract and incipient stage of primary open-angle glaucoma, is a sparing method that minimizes surgical trauma and achieves a persistent hypotensive effect, reduces intraocular pressure to an individual level and stabilizes visual functions in 97.3% of cases.

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About the authors

Benta G. Dzhashi

Fedorov Eye Microsurgery Federal State Institution

Email: benta1@eandex.ru
ORCID iD: 0000-0001-5763-888X
SPIN-code: 9487-2798

Ophthalmologist

Russian Federation, 80 Zemljachki str., Volgograd, 400138

Sergei V. Balalin

S.N. Fyodorov Eye Microsurgery Federal State Institution

Author for correspondence.
Email: s.v.balalin@gmail.com
ORCID iD: 0000-0002-5250-3692
SPIN-code: 5561-2173
Scopus Author ID: 6504016538
ResearcherId: AAL-3746-2021

Doctor of Medical Sciences, Head of the Scientific Department Fedorov Eye Microsurgery Federal State Institution, Volgograd Branch

Russian Federation, 80 Zemljachki str., Volgograd, 400138

References

  1. Egorov EA. Mezhnatsional’noe rukovodstvo po glaukome. Klinika glaukomy. Vol. 2. Moscow: GEOTAR-Media, 2016. 184 p. (In Russ.)
  2. Tarkkanen A, John G, Kivela T. Lindberg and the discovery of exfoliation syndrome. Acta Ophthalmol. Scand. 2002;80(2):151–154. doi: 10.1034/j.1600-0420.2002.800206.x
  3. Schlötzer-Schrehardt U. Pseudoexfoliation Syndrome and Glaucoma. In: Dartt DA, editor. Encyclopedia of the Eye. Elsevier, Academic Press, 2010. P. 539–548. doi: 10.1016/B978-0-12-374203-2.00114-7
  4. Egorov EA, Astakhov YuS, Erichev VP. Natsional’noe rukovodstvo dlya praktikuyushchikh vrachei. Moscow; 2015. (In Russ.)
  5. Gulsum EE, Semih D. Сataract surgery and possible complications in patients with pseudoexfoliation syndrome. Eurasian J Med. 2017;49(1):22–25. doi: 10.5152/eurasianjmed.2016.0060
  6. Agafonova VV, Barinov EhF, Frankovska-Gerlak MS, et al. Patogenez otkrytougol’noi glaukomy pri psevdoehksfoliativnom sindrome. Ophthalmology in Russia. 2010;7(3):106–114. (In Russ.)
  7. Kerimova RS. Simptomokompleks rannikh glaznykh proyavlenii psevdoehksfoliativnogo sindroma (kliniko-ehksperimental’noe issledovanie [dissertation]. Moscow, 2011. 24 p. (In Russ.)
  8. Fabrikantov OL, Mikhina IV. Contemporary aspects of pseudoexfoliation syndrome. Practical medicine. 2012;(4–2):229–232. (In Russ.)
  9. Yur’eva TN. Zakonomernosti i mekhanizmy formirovaniya bilateral’nogo PEHS. Ophthalmolgia. 2011;(2):74–80. (In Russ.)
  10. Latina MA, Park CH. Selective targeting of trabecular meshwork cells: in vitro studies at pulsed and CW laser interactions. Exp Eye Res. 1995;(60):359–371. doi: 10.1016/S0014-4835(05)80093-4
  11. Lee JW, Chan CW, Wong MO, et al. A randomized control trial to evaluate the effect of adjuvant selective laser trabeculoplasty versus medication alone in primary open-angle glaucoma, preliminary results. Clin Ophthalmol. 2014;(8):1987–1992. doi: 10.2147/OPTH.S70903
  12. Lee JW, Wong MO, Liu CC, Lai JS. Optimal selective laser trabeculoplasty energy for maximal intraocular pressure reduction in open-angle glaucoma. J Glaucoma. 2015;24:128–131. doi: 10.1097/IJG.0000000000000215
  13. Malyugin BE, Agafonova VV, Frankovska-Gerlak MZ, et al. Effect of cataract surgery on intraocular pressure in patients with pseudoexfoliation syndrome. The Siberian Scientific Medical Journal. 2015;35(1):48–54. (In Russ.)
  14. Faizullina KhG. Gipotenzivnyi ehffekT fakoehmul’sifikatsiI katarakty s implantatsiei intraokulyarnoi linzy pri pervichnoi zakrytougol’noI glaukome. Point of view. East – West. 2014;(1):91–92. (In Russ.)
  15. Chen PP, Lin SC, Junk AK. The effect of phacoemulsification on the ocular pressure in glaucoma patients: a report by the American academy of ophthalmology. Ophthalmology. 2015;122(7): 1294–1307. doi: 10.1016/j.ophtha.2015.03.021
  16. Georgopopulos GT, Chalkiadakis J. Combined clear cornea phacoemulsification and trabecular aspiration in the treatment of pseudoexfoliative glaucoma associated with cataract. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2000; 238(10):816–821. doi: 10.1007/s004170000174
  17. Malyugin BEh, Timoshkina NT, Dzhndoyan GT, Verzin AA. Rezul’taty ispol’zovaniya fakotrabekulaspiratsii dlya profilaktiki posleoperatsionnoi gipertenzii posle fakoehmul’sifikatsii s implantatsiei IOL na glazakh S psevdoehksfoliativnym sindromom. Glaucoma. 2004;(3):21–24. (In Russ.)
  18. Donaldson KE, Braga-Mele R. Femtosecond laser-assisted cataract surgery. Cataract Refractive Surgery. 2013;(39):1753–1764. doi: 10.1016/j.jcrs.2013.09.002
  19. Buratto L, Rosalia S, Brint S. Cataract surgery with Phaco and Femtofaco Techniques. USA, NJ: Slack Incorporated, 2014. 420 p.
  20. Anisimova SYu, Anisimov SI, Arutyunyan LL, Novak IV. Femto-laser assisted phacoemulsification of cataract combined with non-penetrating deep sclerectomy. Practical medicine. 2017;1(9): 18–21. (In Russ.)
  21. Chang DF. Phaco Chop and Advanced Phaco Techniques. Strategies for Complicated Cataracts. Malyugin BEh, editor. Moscow: Oftal’mologiya, 2018. 414 p. (In Russ.)

Supplementary files

Supplementary Files
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1. Fig. 1. Trabeculocleaning under the goniolens control: a – intraoperative goniolens; b – control of trabeculocleaning

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2. Fig. 2. Fragment of a gonioscopic image in patient K., 65 years old, under conditions of intraoperative staining: a – before trabeculocleaning (the arrow points at stained pseudoexfoliative material on the trabeculum); b – after trabeculocleaning (the arrow points at the state of the tradculum)

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Copyright (c) 2021 Dzhashi B.G., Balalin S.V.

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