Comparação pressórica e visual entre a facoesclerectomia profunda não penetrante e a facotrabeculectomia / Intraocular pressure and visual results from combined surgery: phacoemulsification with non penetrating deep sclerectomy and phacoemulsification with trabeculectomy

OBJETIVO: O presente estudo tem como objetivo comparar os resultados do controle pressórico e acuidade visual (AV) entre a facoesclerectomia profunda não penetrante (FACOEPNP) e facotrabeculectomia (FACOTREC). MÉTODOS: Estudo observacional, retrospectivo através da revisão de prontuários. Foram selecionados 148 olhos de 127 pacientes submetidos à cirurgia no período de janeiro de 1998 a janeiro de 2007 do Instituto de Oftalmologia Tadeu Cvintal em portadores de glaucoma primário de ângulo aberto (GPAA) com diagnóstico de catarata coexistente. Destes pacientes 77 eram do sexo feminino, sendo que 49 (59 por cento) foram submetidos à FACOEPNP e 28 (63,6 por cento) foram submetidos à FACOTREC. Cinquenta pacientes eram do sexo masculino sendo, 34 (41 por cento) submetidos à FACOEPNP e 16 (36,4 por cento) a FACOTREC. O estudo teve duração de 12 meses e os pacientes tiveram pressão intraocular (PIO) (tonômetro de Goldmann) e AV (LogMar) aferidos no pré-operatório e um ano após o procedimento cirúrgico, além do número de medicações hipotensoras oculares que foram adicionados no pósoperatório. RESULTADOS: Os grupos se mostraram homogêneos quanto a AV pré (p = 0,067), AV pós (p = 0,924) e variação da AV (p = 0,099). A média de variação de AV no grupo FACOTREC foi de -0,31 (dp = 0,59) (p < 0,001), enquanto que a média de variação da AV no grupo da FACOEPNP foi de -0,45 (dp 0,51) com p<0,001. A média de variação de PIO no grupo FACOEPNP de -6,2 (dp = 5,1) foi estatisticamente significante (p < 0,001) e a média de variação de PIO no grupo FACOTREC foi de -6,6 (dp = 5,3) (p < 0,001). Não foi encontrada diferença estatisticamente significante entre os grupos quanto ao uso de medicações na avaliação pós (p = 0,398). CONCLUSÃO: A esclerectomia não penetrante (EPNP) combinada com cirurgia de catarata resulta em uma redução da PIO similar a encontrada na FACOTREC com o mesmo resultado com relação a melhor AV.

PURPOSE: the aim of the present study is to compare the intraocular pressure (IOP) and visual acuity (VA) after combined surgery: phacoemulsification with non penetrating deep sclerectomy and phacoemulsification with trabeculectomy. METHODS: this is an observacional and retrospective study by chart review. We selected 148 eyes from 127 patients from Tadeu Cvintal Ophthalmolgy Institute during January 1998 thru January 2007. All patients had primary angle glaucoma and cataract. Seventy seven patients were female, 49 (59 percent) had phacoemulsification with non penetrating deep sclerectomy and 28 (63,6 percent) had phacoemulsification with trabeculectomy. Fifty patients were male, 34 (41 percent) had phacoemulsification with non penetrating deep sclerectomy and 16 (36,4 percent) phacoemulsification with trabeculectomy. The patients had IOP (Goldmann) and VA (LogMar) measured before surgery and one year after surgery, also the number of glaucoma medications that patients had to drop after surgery. RESULTS: the groups were equals comparing VA before (p = 0,067), and after VA (p = 0,924) with variation VA (p = 0,099). The mean VA in the group that had phacoemulsification with trabeculectomy was 0,31 (dp = 0,59) (p < 0,0001), and the mean variation in the group that had phacoemulsification with non penetrating deep sclerectomy was -0,45 (dp 0,51) with p , 0,001. The IOP mean variation in the patients that had phacoemulsification with non penetrating deep sclerectomy -6,2 (dp = 5,1) had stastistically difference (p < 0,001) and the mean variation of IOP in the patients that underwent phacoemulsification with trabeculectomy was -6,6 (dp = 5,3) (p < 0,001). There was no statistically difference between the groups evaluating the glaucoma medications. CONCLUSION: non penetrating deep sclerectomy combined with phacoemulsification causes IOP reduction similar phacoemulsification with trabeculectomy with the same result evaluating VA.

Prospective comparative study between retroperitoneoscopic and hand-assisted laparoscopic approach for radical nephrectomy

OBJECTIVE: No consensus has yet been established regarding the best minimally invasive access for radical ablation of renal tumors. Our objective was to prospectively compare the surgical results and oncologic management of two currently used endoscopic techniques. MATERIAL AND METHODS: Over a four-year period, 50 patients with renal tumors and clinical stage T1b-T2, smaller than 12 cm, underwent a radical nephrectomy at two reference institutions, 25 underwent retroperitoneoscopic radical nephrectomy (RRN) and 25 a hand-assisted laparoscopic radical nephrectomy (HALRN). Mean follow-up of both cohorts was 50 months. Operative parameters and oncological management were compared. RESULTS: The mean operative time was 180 min in RRN and 108 min in HALRN (p < 0.001). The time required to access the renal pedicle in RRN was 30 min. and in HALRN 40 min., Learning curve was shorter in HALRN than RRN. Mean blood loss was 100 mL in RRN and 242 mL in HALRN. Mean incision size for specimen retrieval in RRN was 6.5 cm and in HALRN 7.5 cm. One patient with intra operative occurrence of ascites and subsequent pathological stage pT2N0M0 grade 3 operated via HALRN, had neoplasic implants in the Hand-port incision 3 months after surgery followed by death 4 months after recurrence. One patient, with pathological stage pT3N0M0 grade 3 in RRN had metastasis after 36 months. CONCLUSION: Both, RRN and HALRN techniques are accepted minimally invasive options for endoscopic radical nephrectomy with equivalent long term oncological outcome in the treatment of renal tumors.