ABSTRACT
Cataract surgery in glaucoma patients remains a controversial subjects. Indication of surgery depends on a lot of clinical parameters: diagnosis, state, evolution of glaucoma as well as compliance with medical treatment--surgical procedures of cataract and glaucoma--sites of the surgery--use of antifibrosis agents and surgeon's experience. As cataract extraction alone decreases the intraocular pressure in open angle glaucoma and mainly in uncomplicated closed angle glaucoma and trabeculectomy alone reduces the intraocular pressure more than combined surgery with less complications we recommended the following surgical options: Cataract extraction alone in patients with controlled open angle glaucoma and in patients with closed angle glaucoma. A two step procedure: filtering surgery followed by cataract extraction in patients with poorly controlled open angle glaucoma or mixed closed angle glaucoma. Ambulatory surgery and topical anesthesia permit a two stages surgery with less inconveniences. A combined procedure in patients with a chronic closed angle glaucoma where filtering procedure alone is associated with important complications. Actually, the best surgical cataract procedure is phacoemulsification with a small supero-corneal incision and implantation of a foldable intraocular lens. The best filtering procedure remains trabeculectomy, or the new non penetrating trabecular surgery for experimented surgeons, in the superior quadrant. In the future new surgical procedures and new safe and non toxic pharmacologic drugs which modulate wound healing could be found in order to increase the efficacity and indications of combined surgery.
Subject(s)
Cataract Extraction , Cataract/complications , Glaucoma/complications , Glaucoma/surgery , Ophthalmologic Surgical Procedures , HumansABSTRACT
Non perforating trabecular surgery (NPTS) with reticulated hyaluronic acid implant (Skgel) allows aqueous humor to leave anterior chamber through a thin trabeculo-Descemet's membrane into a sclerocorneal space filled with Skgel implant and then via the outflow physiological channels. Good intraocular pressure results are obtained with less or without external filtration decreasing the incidence of per- and postoperative complications found after trabeculectomy. This surgery is actually only indicated for primary open angle glaucoma, the trabeculectomy still remaining the gold standard procedure for the other glaucoma cases.
Subject(s)
Glaucoma Drainage Implants , Glaucoma, Open-Angle/surgery , Hyaluronic Acid , Trabecular Meshwork/surgery , Female , Follow-Up Studies , Humans , Intraocular Pressure , Male , Middle Aged , Trabeculectomy/adverse effects , Trabeculectomy/methods , Treatment OutcomeABSTRACT
PURPOSE: To measure the effect of topical betaxolol 0.5% and timolol 0.5% on retinal vessels diameters by means of photographic enlargement. METHODS: Thirteen glaucomatous patients (primary open angle glaucoma (POAG) and ocular hypertensive (OH)) were treated twice daily with betaxolol 0.5% for one year. These same patients were subsequently treated with timolol 0.5% during the following year. Fundus photographs were taken with Canon camera 30 degree angle at baseline and two hours after instillation at 3, 6 and 12 months of treatment for each drug. The diameters of the superior and inferior temporal vessels (arteries and veins) were measured at one and two disc radii from the margin of the disc using photographic enlargement (x 66.7) of the right eye and were analysed under double masked fashion during the same session. RESULTS: A significant increase of the mean arterial diameter (+ 7.4% p = 0.000 paired t) was found after 12 months of betaxolol treatment, while no persistent further difference (+ 1.3% NS) was found after 12 months of timolol treatment. No modification was found in venous diameter. CONCLUSION: Betaxolol treatment is associated with a beneficial effect on retinal arteries width whereas Timolol does not yield the same amplitude of benefit.
