Early results of modified nonpenetrating deep sclerectomy and phacoemulsification in the treatment of open angle glaucoma and cataract.

Abstract

PURPOSE:

To study the outcome and control of intraocular pressure (IOP) of a combined modified nonpenetrating deep sclerectomy (NPDS) without use of implants and phacoemulsification in patients with primary open angle glaucoma (POAG) and cataract.

METHODS:

Prospective series of 14 eyes in 14 patients with medically uncontrolled POAG and cataract with significant visual impairment undergoing a modified NPDS and phacoemulsification. The surgery was designed to utilize all four mechanisms of outflow track of aqueous of NPDS without the use of scleral implant and a standardized postoperative management and early Nd:YAG laser goniopuncture at 4 weeks. All patients underwent clinical assessment before and after surgery at day 1, day 7, weeks 2, 3, and 4, and then at 2, 3, and 6 months postoperation. Surgical outcome was assessed in terms of IOP, visual acuity, and the incidence of complications.

RESULTS:

IOP decreased significantly from a preoperative value of 21.71+/-3.81 mmHg (mean +/- SD) to a postoperative value of 13.14+/-3.73 mmHg (mean +/- SD) (p<0.05, paired t test) at 6 months. The number of antiglaucoma eyedrops needed for control of IOP decreased from 3.28+/-0.91 to zero after operation at 6 months follow-up. The change in IOP pre and post laser goniopuncture was noted with no complication or fluctuation in anterior chamber depth. Visual acuity ranged from finger counting to 6/18 with Snellen chart at 6 meters preoperatively to 6/36 to 6/9 postoperatively. There were no intraoperative complications. There was one recessed conjunctival wound at 1 week. No other postoperative complication was noted.

CONCLUSIONS:

Modified NPDS without scleral implant with early Nd:YAG laser goniopuncture and phacoemulsification for treatment of patients with POAG and cataract is a safe and effective procedure with complete success at 6 months.

• Authors: N S Y Yuen
• Journal: European journal of ophthalmology (Eur J Ophthalmol) 2009 Jan-Feb Vol. 19 Issue 1 Pg. 72-9 ISSN: 1120-6721 [Print] United States
• PMID: 19123152 (Publication Type: Journal Article)

Topics

• Aged
• Aged, 80 and over
• Cataract (complications, therapy)
• Female
• Glaucoma, Open-Angle (complications, surgery)
• Humans
• Intraocular Pressure (physiology)
• Intraoperative Complications
• Male
• Middle Aged
• Phacoemulsification (methods)
• Postoperative Complications
• Prospective Studies
• Sclerostomy (methods)
• Tonometry, Ocular
• Treatment Outcome
• Visual Acuity (physiology)