информационное письмоEYE HYDRODYNAMICS AFTER COMBINED YAG-LASER ACTIVATION OF TRABECULA AND PHACOEMULSIFICATION IN THE TREATMENT OF PRIMARY OPEN-ANGLE GLAUCOMA AND COEXISTING CATARACT
DOI:
https://doi.org/10.31618/asj.2707-9864.2021.2.45.76Keywords:
primary open-angle glaucoma, combined treatment, YAG-laser activation of trabecula, phacoemulsification, laser photometryAbstract
Abstract. The aim is to study the mechanism of action of YAG-laser activation of trabecula (YAG-LAT) with subsequent phacoemulsification and to investigate the state of eye hydrodynamics after the proposed technology of combined treatment of primary open-angle glaucoma (POAG) and coexisting cataract.
Material and methods. The clinical study included 70 patients (70 eyes) with initial, advanced stages of POAG and coexisting cataract. There were 42 women (60%) and 28 men (40%), the median age of patients was 68.8±8.2 years.
In the course of the study two groups of patients were formed: the main group – 36 patients (36 eyes), who underwent combined treatment – YAG-laser activation of trabecula and phacoemulsification; and the control group – 34 patients (34 eyes), who underwent phacoemulsification alone. The follow-up period is up to 2 years after treatment. The baseline IOP by Maklakov in the combined and control groups was 24.1±2.52 mm Hg and 23.0±2.41
mm Hg respectively. The mean medication use was 1.53±0.65 in the combined group and 1.44±0.50 in the control group.
The degree of opalescence of the aqueous humour in the anterior chamber was assessed by laser photometry, or tindalemetry (FS-2000, KOWA, Japan). Laser flare and cell photometry was performed on patients of the main group (10 eyes) at the stages of combined treatment.
Results. There were no intraoperative complications in patients of both groups. On the first day ocular hypertension was in 8.3% of cases after the combined treatment and in 32.4% of cases after phacoemulsification.
In the long-term postoperative period (24 months), the mean IOP reduction (by Maklakov) was 18.64±1.31 mm Hg (decreased by 21.1% compared to the baseline IOP) in the main group; 21.36±1.91 mm Hg (did not significantly differ from the baseline IOP, p=0.234) in the control group. The mean outflow facility increased from 0.10±0.02 to 0.20±0.03 mm3/min/mm Hg in the main group (p<0.0001) and has not changed in the control group.
The mean medication use decreased from 1.53±0.65 to 0.64±0.56 in the combined group (p<0.0001), and increased from 1.44±0.50 to 1.92±0.28 in the control group (p=0.001).
According to the results of laser photometry, the mean opalescence value increased almost 3 times compared to the initial value after YAG-LAT (p<0.0001), and it decreased almost to the initial value after phacoemulsification (p<0.001).
Conclusion. The developed technology of combined treatment of POAG and coexisting cataract allows to achieve normalization of IOP after YAG-LAT with phacoemulsification by increasing the outflow facility according to tonography data and has a pathogenetic orientation, confirmed by the results of laser photometry.
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