Dergiler / MN Oftalmoloji / 2004 / Cilt: 11 - Sayı: 4
Primer açık açılı glokom ve psödoeksfolyatif glokom olgularında fakotrabekülektomi ameliyatı etkinliğinin karşılaştırılması
- Dergi
- MN Oftalmoloji
- Sayfa
- 306–310
- DOI
- —
Özet
Amaç: Fakotrabekülektomi ameliyatının primer açık açılı glokom (PAAG) ve psödoeksfolyatif glokom (PEG) olgularında göz içi basıncı (GİB), görme keskinliği, glokom ilaç sayısı ve komplikasyon oranları üzerindeki etkisinin karşılaştırılması amaçlandı. Gereç ve Yöntem: Kataraktı olan ve tıbbi tedavi ile GİB kontrolü sağlanamayan 25 PAAG ve 18 PEG hastasına, 5 olgu iki taraflı olmak üzere 48 kombine ameliyat (fakotrabekülektomi) uygulandı. Tüm olgularda cerrahi teknik olarak temporal yaklaşımlı fako+süperior trabekülektomi ile katlanabilir akrilik göz içi lensi (GİL) implantasyonu kullanıldı. PAAG grubu 1. grup (n=28), PEG grubu 2. grup (n=20) olarak sınıflandırıldı ve sonuçlar karşılaştırıldı. İstatistiksel değerlendirmelerde t-testi, paired t-test, Wilcoxon signed rank test ve Mann-Whitney U testi kullanıldı. İstatistiksel anlamlılık p 0.05). Yetersiz midriyazis ve fibrinoid reaksiyon 2. grupta istatistiksel olarak anlamlı oranda yüksekti (p<0.05). Fakoemülsifikasyon ile kombine trabekülektomi ameliyatını, her iki glokom tipi için de etkili ve güvenilir bir cerrahi yöntem olarak değerlendirmekte ve önermekteyiz
Abstract
Purpose: To compare the efficacy of phacotrabeculectomy intraocular pressure (IOP), visual acuity, the number of required antiglaucomatous drugs and the complication rates in patients with primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG). Material and Methods: Twenty five POAG patients and 18 PEXG patients having cataracts, and whose IOP could not be controlled with maximum medical therapy were operated with phacotrabeculectomy tecnique. In 5 patients phacotrabeculectomy surgery was performed bilaterally. In all cases temporal corneal incision with superior trabeculectomy and foldable acrylic intraocular lens implantation were preferred. POAG patients (n=28) comprised the first group and PEXG patients (n=20) comprised the second group. Results were compared using t-test, paired t-test, Wilcoxon signed rank test and Mann-Whitney U test. P value less than 0.05 was considered significant. Results: The mean age was 57.7±7.8 years in the first group and 68.2±5.2 years in the second group. Patients were followed up the mean 18.8±3.4 months in the first group and 18.2±4.7 months in the second group. The mean preoperative IOP was 28.2±3.7 mmHg in the first group and 28.9±3.5 mmHg in the second group. At the last follow up examination the mean IOP was 15.2±3.2 mmHg in the first group and 13.9±2.3 mmHg in the second group. Preoperative Snellen visual acuity mean level was 0.15±0.1 in the first group and 0.14±0.1 in the second group. Postoperative visual acuity at the last examination mean level was 0.66±0.2 in the first group and 0.55±0.2 in the second group. The number of preoperative antiglaucomatous drugs mean was 2.1±0.5 in the first group and 2.3±0.5 in the second group. At the last follow up the number of antiglaucomatous drugs mean was 0.1±0.3 and 0.15±0.5 in the first and second groups respectively. Conclusion: In both groups, the decrease in IOP and the number of antiglaucomatous drugs and the increase in visual acuity after surgery were found to be statistically significant (p<0.001). These parameters were not significant when two groups were compared (p>0.05). Sufficient mydriazis and fibrinoid reaction were significantly higher in the second group (p<0.05). As a result phacoemulsification combined with trabeculectomy is effective and safe in both glaucoma types