|Oscar V Beaujon-Balbi, Claudia L Pabon, Oscar Beaujon-Rubin
Pan Am J Ophthalmol 2014, 13:106 (2 October 2014)
Cataract and glaucoma patients represent a challenge for the anterior segment surgeon due to either perform a cataract or glaucoma surgery alone or a combined procedure. We present the results of combined cataract phacoemulsification, intraocular lens implant and MMC trabeculectomy with releasable sutures. Sixty eyes of 44 patients were included from January 2008 to December 2011, with a mean age of 67.02±10,41) years old. 80% were primary open angle glaucoma (POAG) and 20% primary closed angle glaucoma (PCAG). Preoperative intraocular pressure was 23.28±5.89 mmHg; 26.08±10.66 for GPAA and 26.08±10.66 for GPCA with a cup/disc ratio of 0.81 and 0.74, respectively. Best corrected visual acuity (in LogMar) was 0.581 preoperatively, improved to 0.28±0.40 postoperatively in both groups with 0.60±0.41 to 0.25±0.37) in GPAA and 0.53±0.44 to 0.39±0.40 in GPCA. The intraocular pressure was reduced in 48.24% with 48.86% in GPAA and 52.72% in GPCA. The survival curve analysis was 0.91 in GPAA and 0.90 in GPCA at 50 and 30 months. In conclusion, combined surgery was successful in treatment patients with glaucoma and cataract.
La asociación de catarata y glaucoma representa un reto para el oftalmólogo que debe decidir si realiza una cirugía de glaucoma o catarata o combinada. Presentamos nuestros resultados de cirugías de facoemulsificación de catarata, implante intraocular y trabeculectomía con MMC y suturas retirables.Se incluyen 60 ojos de 44 pacientes operados de Enero 2008 a Diciembre de 2011 con una edad promedio de 67,02±10,41) años. El 80% eran glaucomas de ángulo abierto (GAA) y 20% por cierre angular (GPCA). La presión intraocular previa fue de 23,28± 5,89 mmHg en GPAA y 26,08±10,66 en GPCA con una relación excavación/disco fue de 0,81 y 0,74, respectivamente. La agudeza visual preoperatoria mejor corregida (LogMar) fue de 0,581±0,41 mejorando a 0,28±0,38) en general y 0,60±0,41 a 0,25 ±0,37 en GPAA y 0,53±0,44 a 0,39±0,40 en GPCA. La reducción de la presión intraocular fue de 48,24% en promedio siendo del 48,86% en GPAA y 52,72% en GPCA. La sobrevida de la cirugía fue de 0,91 en el glaucoma de ángulo abierto y de 0,90 en el glaucoma por cierre angular a los 50 y 30 meses de seguimiento respectivamente. En conclusión, la cirugía combinada por un solo puerto es efectiva en el control del paciente con glaucoma y catarata.
Palabras clave: catarata; glaucoma; tratamiento quirúrgico.
|Luis Alberto Suazo, Paulina Liberman, Fuad Gauro, M Mario T. Zanolli
Pan Am J Ophthalmol 2014, 13:44 (2 April 2014)
Purpose: Strabismus (heterotropia) is one of several possible complications of ocular traumatic injury. This condition is associated with a decreased quality of life. The purpose of this study is to report the functional outcomes of a series of 35 patients presenting with strabismus secondary to eye trauma.
Methodology: Retrospective study. Treatments for each type of post-traumatic ocular lesion were categorized, which included conservative management by clinical observation; use of a lens with prismatic addition; intramuscular injection of botulinum toxin; or surgery. Strabismus conditions were evaluated prior to the treatment and six months after the last treatment had been received. The rate of therapeutic success, defined as ±10 PD (prism diopters) was assessed.
Results: The orbital injuries that most commonly caused strabismus were found to be orbital fracture, penetrating eye injury and direct muscle trauma. All cases of direct muscle trauma received surgical treatment; 54% of orbital fractures resolved spontaneously during clinical observation, whereas 38% required surgery. Three cases of penetrating eye injury were observed and three were treated surgically. The rate of therapeutic success was 88.57%. A single treatment was sufficient for 88.6% of all cases.
Conclusions: Non-surgical therapeutic clinical observation is sufficient in a significant percentage of cases because a large number of patients tend to spontaneous recovery. Additional techniques, such as treatment with botulinum toxin, can have a useful complementary role. Surgical intervention, assessed on a case by case basis, also turned out to be highly effective in the minority of cases where it was required.
|Carolina Engelbrecht, Tatiana T Azzi, Mauricio D Paolera, Niro Kasahara
Pan Am J Ophthalmol 2014, 13:10 (1 January 2014)
Purpose: To compare the fluctuation of the ocular perfusion pressure (OPP) between eyes treated with glaucoma medication and eyes with a functioning filtering bleb.
Study Design: cross-sectional controlled paired-eye design.
Methods: Fourteen patients with primary open angle glaucoma (POAG) with one eye operated on (trabeculectomy) and the fellow eye treated with medication enrolled the study. Blood pressure and intraocular pressure were measured at 7 a.m., 1 p.m., and 7 p.m. Systolic, diastolic and mean OPP were calculated for the three time points and the fluctuation (range between the highest and the lowest values) compared between the eyes.
Results: Mean values of the mean OPP fluctuation were 7.2 ± 3.9 mmHg and 8.5 ± 4.0 mmHg, for operated eyes and medically treated eyes, respectively (P = 0.149); mean systolic OPP fluctuation was 20.7 ± 11.2 mmHg for operated eyes and 21.2 ± 11.7 mmHg for medically treated eyes (P = 0.478); the mean diastolic OPP fluctuation was 8.4 ± 4.4 mmHg for operated eyes and 10.5 ± 5.4 mmHg for medically treated eyes (P= 0.085).
Conclusion: In this small cohort of patients with POAG, the mean, systolic and diastolic OPP fluctuation did not differ between the operated eyes and medically treated ones.