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Results of phacoemulsification and segmental Schlemm's canal dilation in cataract patients suffering from open angle glaucoma refractory to previous glaucoma surgeries

Poster Details

First Author: G.Dushina RUSSIA

Co Author(s):    V. Kumar   M. Frolov   A. Shradqa   A. Bezzabotnov           

Abstract Details

Purpose:

To evaluate the safety and efficacy of phacoemulsification and segmental dilation of Schlemm's canal (SC) using a stainless steel spiral Schlemm's canal expander (SCE) in decreasing intraocular pressure (IOP) and hypotensive medication(s) use in cataract patients with open angle glaucoma (OAG) refractory to previous glaucoma surgeries.

Setting:

Ophthalmic unit of Skhodnya city hospital, Moscow province; People's friendship university of Russia Medical Institute Department of Ophthalmology, Moscow, Russian Federation.

Methods:

Medical records of nine cataract patients suffering from OAG refractory to previous glaucoma surgeries and having undergone phacoemulsification with implantation of SCE between May, 2014 and December, 2015 were retrospectively evaluated. The 5mm long spiral device made from 0.05mm thick medical grade stainless steel wire (inner lumen diameter - .15mm, outer - .25mm) was implanted into SC ab externo after cataract surgery. Outcome measures: IOP change, number of glaucoma medications and complications. Success rates were evaluated using World Glaucoma Association's guidelines. A paired t-test was used for analysis. Results were significant when p less than .05. Follow up >12 months.

Results:

At 1, 3, 6 and 12 months mean IOP reduced from baseline IOP of 24.6+/–7.2mmHg to 12.8+/–4.1(p=.0036), 13.8+/–7(p=.01708), 12.6+/–3.3(p=.00384) and 12.1+/–3.7mmHg (p=.0040); use of medications reduced from 2.4+/–.9 to .1+/–.3 (p=4.05E-05), .4+/–.9(p=2.85E-05), .8+/–1.2(p=.00010) and .9+/–1.2(p=.0007); complete success was achieved in 89(8/9), 78(7/9), 67(6/9) and 56%(5/9) cases respectively. Intra-operatively micro-perforation of trabecular meshwork occurred in 2 cases. Gonioscopicaly the devices's one end was lying in the anterior chamber angle in these cases. There was no failure case. Fluorescein canalography showed complete occlusion of collector channels only in 2 cases (22%).

Conclusions:

It is plausible that in some failed filter cases, there could be patent post-trabecular outflow. Fluorescein canalography in the present study showed patent post-trabecular outflow in 78% cases (7/9) and implantation of device into SC lumen could control IOP with or without medications in 100% cases. The study further showed that it was safe to implant the device in SC lumen in all cases. Hence it can be concluded that implantation of SCE is a safe and effective procedure in reducing IOP in cataract patients suffering from OAG cases refractory to previous filtering glaucoma surgeries.

Financial Disclosure:

gains financially from product or procedure presented

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