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First Author: S.Pinchuk UKRAINE
Co Author(s): M. Karliychuk
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Using the EX-PRESS glaucoma filtration device (Alcon Laboratories, Inc., Fort Worth, TX) in glaucoma surgery both separately and with phacoemulsification shows good results with minimum of complications. Early superfluous scarring remains one of postsurgical problems that cause reducing of hypotensive effect. Local anti-metabolites resolve this problem but have some complications. The purpose of study was to analyze efficacy of anterior lens autocapsule drainage with EX-PRESS implantation usage in combined cataract-glaucoma surgery.
Eye microsurgery clinic Vash Zir, Chernivtsi, Ukraine.
The study comprised 28 eyes of 24 patients with a mean age of 64,3ḟ8,24 years with senile cataract grading of nuclear density between 2 and 4 and medically uncontrolled primary open-angle glaucoma. Uncontrolled glaucoma was defined as intraocular pressure (IOP) greater than 21 mm Hg on maximum tolerated medical treatment. Patients underwent ultrasound phacoemulsification with intraocular lens implantation combined with EX-PRESS glaucoma filtration device implantation. In all cases careful Tenons capsule removal was performed and none anti-metabolites were used. Technique of autocapsule drainaging after EX-PRESS device implantation consisted in fixation of anterior lens capsule to the scleral spur by nylon 10-0 and smoothing out to be visible from under the scleral flap. Scleral flap was fixed by four sutures. Postsurgical evaluation was performed next day, 1, 3, and 12 months postoperatively. Level of IOP, filtering bleb appearance, frequency of needling procedure were determined.
The mean presurgical IOP was 32,2ḟ11,16 mm Hg. Next day moderate hypotonia was observed 10,4ḟ4,58 mm Hg. 1, 3, and 12 months postsurgically the mean IOP was 14,3ḟ3,66 mm Hg, 11,8ḟ1,98 mm Hg and 12,6ḟ2,21 mm Hg, respectively. In all cases diffuse, functioning filtering bleb was formed. In two cases needling procedure was performed at first month postsurgically due to early superfluous scarring.
Majority of patients after anterior lens autocapsule drainage with EX-PRESS implantation usage in combined cataract-glaucoma surgery has constant IOP reduction 1 year after surgery with absence of complications. Our results suggest that good long-term control of IOP can be achieved by means of this method as alternative to local anti-metabolites.