Pseudophacodenesis And Glaucoma With Elevated Intraocular Pressure – Tactics, Surgery And Results

Purpose. 1) To define the approach to surgical treatment of pseudophacodonesis associated with decompensated glaucoma on the basis of anatomo-topographic characteristics of the anterior eye segment. For the first time, IOP gradient along the movements of IOL-capsular bag complex was estimated and a dependence on the amplitude and frequency of the complex's oscillations was discovered, based on mathematical calculations. A displacement of more than 0.1 mm is significant; normally it does not exceed hundredths of a millimeter; with pseudophacodonesis, the increase in distance in the supine position can reach 0.6 mm. 2) To analyze the results of combined treatment –suture IOL fixation to the iris and non-penetrating deep sclerectomy (NPDS).

Settings – IRTC Eye Microsurgery Ekaterinburg Center, Ekaterinburg, Russian Federation.

Methods. Patients with elevated IOP and pseudophacodonesis underwent optical coherence tomography in a vertical position and ultrasound biomicroscopy in a horizontal position. The distance from the line connecting the scleral spurs to the anterior IOL surface was estimated at the pupil centre. If it was more than 0.1 mm, combined surgery was performed - flange fixation of the IOL-capsular bag complex to the iris (polypropylene 9.0) using 2 haptics and microinvasive NPDS: 40 eyes of 39 patients aged from 65 to 91 years (mean,78.05±5.84). BCVA before surgery was 0.5±0.2 (range, 0.03 to 0.85); mean IOP with hypotensive therapy was 33.05±9.9 mm Hg (range, 19 to 61 mm Hg). In 1 case vitreous prolapse with anterior vitrectomy was marked.

Results. Post-op follow-up terms was 29.2±11.26 months (range, 12 to 53 months.). In the early post-op period, there were hemorrhagic events in 3 eyes (8%), hypertension in 2 eyes (5%), choroidal effusion – in 1 (3%). BCVA in the late post-op period was 0.49 ±

0.27, IOP was 15.1 ± 6.81 mm Hg. In 30 eyes repeated glaucoma surgery was required in terms from 6 to 44 months (mean, 18.6 ± 12.9 months). Cystoid macular edema was marked in 3 eyes (8%).

Conclusions. 1) With pseudophacodonesis and excursion of the IOL – capsular bag complex less than 0.1 mm (in vertical and horizontal position) glaucoma surgery without additional IOL fixation is indicated; if the excursion exceeds 0.1 mm, additional IOL fixation is necessary.

2) Functional results of combined surgery showed stable visual functions and low complication rate in the early and remote post-op period.