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Chirurgie Combinée Cataracte-glaucome: Comparaison entre Phacoemulsification associée à une Sclerectomie profonde, ou a une trabéculectomie

Klinische Monatsblatter Fur Augenheilkunde - KLIN MONATSBL AUGENHEILK 01/1997; 210(05):256-260. DOI: 10.1055/s-2008-1035049
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    ABSTRACT: To compare the outcome of phacoemulsification-intraocular lens (IOL) implantation combined with nonperforating deep sclerectomy (P-DS) with that of phacoemulsification-IOL implantation combined with trabeculectomy (P-T). Glaucoma Unit, Department of Ophthalmology, University of Lausanne, Switzerland. This prospective study involved 60 eyes of 60 patients with cataract and various types of open-angle glaucoma. Thirty eyes had P-DS and 30, P-T. Follow-up was performed at regular intervals for up to 18 months. Mean follow-up was 12.5 months +/- 6.5 (SD) and 12.6 +/- 4.9 months for the P-DS and P-T groups, respectively. Mean preoperative intraocular pressure (IOP) was similar in both groups (24.8 +/- 5.9 mm Hg in the P-DS group and 24.6 +/- 7.2 mm Hg in the P-T group). There was no statistically significant difference in IOP decrease (14.2 +/- 4.0 mm Hg in the P-DS group and 15.2 +/- 2.8 mm Hg in the P-T group). Visual outcome was similar in both groups. The P-DS group experienced significantly less inflammation (40.0% versus 83.0%; P = .0012) and hyphema (6.7% versus 36.7%; P = .010) than the P-T group. Deep sclerectomy combined with cataract surgery resulted in an IOP reduction similar to that with phacotrabeculectomy with the same visual outcome, but the lower complication rate makes ambulatory care easier.
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    ABSTRACT: Filtering procedures have been the gold standard in glaucoma surgery for more than 30 years. Trabeculotomy, deep sclerectomy, and viscocanalostomy might become the procedures of first choice in the future. These new, non-penetrating procedures have not yet been compared to filtering procedures in prospective randomized studies with long-term follow-up. In addition, it is not really known how they modify outflow of the aqueous humor. The surgical technique is described and the most likely underlying effects are discussed. Fistulierende Glaukomoperationen galten in den vergangenen Jahrzehnten als Standardoperation beim Glaucoma chronicum simplex. Möglicherweise könnten die Trabekulotomie, die tiefe Sklerektomie und die Viskokanalostomie in den kommenden Jahren als chirurgische Techniken die fistulierenden Eingriffe als Operationen erster Wahl ablösen. Die Wirkprinzipien dieser neuen, nicht penetrierenden Techniken sind dabei im Detail noch nicht untersucht. Anhand eines klinisch orientierten Erfahrungsberichtes werden mögliche Wirkprinzipien aufgezeigt.
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