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Methods of carrying out a phacoemulsification in patients with primary open-angle glaucoma and the complicated cataract

Poster Details

First Author: A.Postupaev RUSSIA

Co Author(s):    N. Postupaeva   E. Sorokin           

Abstract Details



Purpose:

studying of technical methods when performing phacoemulsification for minimization of complicating factors in eyes with primary open-angle glaucoma (POAG).

Setting:

The Khabarovsk branch of the State Institution Eye Microsurgery Complex named after S.N. Fyodorov, Khabarovsk, Russia

Methods:

43 patients (43 eyes) with a combination of a cataract, POAG, factors of high risk of performance of a phacoemulsification: rigid pupil, dense nucleus of a lens, incomplete dislocation of a lens of the I degree. Age of patients: 53-81 years. Men were 22, women - 21. Distribution on POAG stages: I - 12 eyes, II - 14 eyes, III - 17 eyes. Intraocular pressure (IOP) level - 10-15 mm hg, on the average 13.3 mm hg. In all 43 eyes surgical antiglaucoma operations were executed earlier. Visual acuity from 0.4 to 0.01, on the average 0,1. In all eyes - a dense nucleus of a lens, a lens incomplete dislocation, defects of Zinn's ligament tissues to 1/3 circles, a rigid pupil (maximum mydriasis - 4-4,5 mm). Phacoemulsificator 'Infinity' (Alkon) was used, corneal section 1.8-20 mm long.

Results:

Own technique of mydriasis (application for patent of the Russian Federation 2013113715, priority of 28.03.2013): on the operating table before phacoemulsification - a mix injection: 0,02 ml of 1% adrenaline, 0,02 ml of 1% mesaton, 0,01 ml of 2% lidocaine. Entered into limb area by insulin syringe in three points. In 30-40 seconds the mydriasis 5-6 mm was reached. Duration of the mydriasis made 15-20 minutes. It allowed to execute capsulorhexis with diameter of 5-5.5 mm. The break of a nucleus was carried out mechanically (minimization of impact on Zinn's ligament) (application for patent of the Russian Federation 2013117726, a priority of 18.04.2013). Using 2 phacochopper we made simultaneous movements by them towards each other, breaking a nucleus at first on two halves, then on 2-3 fragments. Fragments were removed in pupil area in the anterior chamber. It allowed to execute a phacoemulsification of fragments of a nucleus at a narrow pupil. Phacoemulsification passed without complications. Various models of intraocular lenses were implanted into a capsular bag. Visual acuity without correction in 1-2 days increased in all eyes, having made from 0.2 to 1.0, on the average - 0.6. The IOP level in 2 days remained normalized in all eyes.

Conclusions:

The described techniques can be used when performing phacoemulsification in eyes with primary open-angle glaucoma with risk factors of intraoperative complications. FINANCIAL INTEREST: NONE

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