One stage verses two stage surgeries for cat and glaucoma

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1. One stage combined surgery versus two stage surgeries for coexisting glaucoma and cataract Kumar Vinod Dushin Nicholai Vasilievich Isufaj EdmondOphthalmic unit of…
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  • 1. One stage combined surgery versus two stage surgeries for coexisting glaucoma and cataract Kumar Vinod Dushin Nicholai Vasilievich Isufaj EdmondOphthalmic unit of Skhodnya city hospital, MoscowregionDepartment of ophthalmology, Russian people’sfriendship university, Moscow, Russia.
  • 2. Introduction Surgical treatment for coexisting cataract and glaucoma Two stage surgeries One stage surgery Glaucoma surgery  SICS + IOL + glaucoma surgery SICS + IOL Phaco + IOL + penetrating Phaco + IOL + Non-penetrating glaucoma surgery glaucoma surgery «One-site» «Two-site»
  • 3. ObjectiveTo investigate the surgical outcome ofone stage 2-site combined surgery forcoexisting glaucoma and cataract andcompare the results of this procedurewith the results of cataract surgery intrabeculectomized eyes.
  • 4. Participants one stage two stage Patient demographics surgery surgeries group (PIT) group (TPI)Number of cases (male/female) 26 (12/14) 34 (19/15)Age in years (Mean + SD) 72.6 + 6.7 72.8 + 6.5Visual acuity: 4/8/4/10 8/7/3/16 prpl/0.01-0.03/0.04-0.09/0.1Glaucoma stage: 2/18/6 0/22/12 I/II/III 22/4 33/1 a/bComplicating factors: 1 3 lens swelling 2 1 lens subluxation 2 2 pseudo exfoliation
  • 5. Methods Complete ophthalmic examination  Snellen’s visual acuity, slit-lamp examination, IOP readings with Maklakov’s tonometry Inclusion criteria  patients with open angle glaucoma, undergone trabeculectomy procedure, operated by one surgeon and with a follow-up not less then 6 months Outcome measures  visual acuity; intraocular pressure and complications arising intraoperatively, in early and late post- operative period Statistical analysis  P < 0.05 statistically significant
  • 6. Surgical technique Two site surgery, fornix based conjunctival flap Clear corneal incision phacoemulsification of cataract Use of trypan blue (25 cases, 96.1%-PTI; 32 cases, 94.1%-TPI) iris-hooks (18 cases, 69.2%-PTI; 19 cases, 55.9%-TPI) Phacoemulsifier system Galaxy – I, with peristaltic pump (Appasamy associates, India) Stop and Chop, quick Chop US: pulse mode (8p/s) and micropulse mode (25p/s)
  • 7. Video
  • 8. Results (visual acuity, IOP) Number of cases Post PIT group TPI group operative P value period VA<0.5 VA>0.5 VA<0.5 VA>0.51st day 26 0 23 11 0.00011st week 22 4 16 18 0.00031th month 14 12 10 24 0.063rd month 12 14 12 22 0.26th month 12 14 12 22 0.2IOP (last follow-up): Under control in both groups, no additional medication prescribed
  • 9. Results (Intraoperative observations andcomplications) Number of casesIntraoperative observations and P complications PIT group TPI groupSurgical complication rate 15.4% 52.9% 0.001Synechialysis required 0 11Prolonged irrigation requiredbecause of petechial 2 8hemorrhage from pupil marginPC rupture (vitreous loss) 0 2 (1) 0.001CCC rupture 0 1CTR implanted 2 1Iris prolapsed from incision 1 1US on time in sec. (Mean +/-SD) 101 +/- 25 104.5+/-32 0.62
  • 10. Results (Early postoperative complications) Number of cases (%)Early postoperativeobservations andcomplications PIT group TPI groupHyphema 1 ( 3.8) 9 (26.5)1st degree Inflammation 2 ( 7.7) 1 ( 2.9)2nd degree Inflammation 6 (23.1) 8 (23.5)(exudative reaction)Choroidal detachment 7 (26.9) 16 (47.1)Bleb leak 1 ( 3.8) 6 (17.6)High IOP 0 3 ( 8.8)Additional surgical 4 (15.4) 25 (73.5)intervention required: sclerectomy 3 16 lens extraction + IOL 0 3 extra suture applied 1 6
  • 11. Results (Late postoperative complications) Number of casesLate postoperativeobservations andcomplications PIT group TPI groupDeformed pupil 18 19Anterior capsule fibrosis 2 1Iridocyclitis 0 2PCO requiring Nd:YAGlaser capsulotomy 0 3Time range: 52 weeks - 1weeksBullous keratopathy 0 1 p 0.814
  • 12. Conclusion One stage combined surgery is a safer and effective procedure for co-existing glaucoma and cataract.
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