Evaluación de resultado del tratamiento quirúrgico en el glaucoma avanzado / The outcome of surgical treatment in advanced glaucoma

Introducción Existe incertidumbre con respecto a los resultados de la cirugía de glaucoma para pacientes con glaucoma avanzado, ya que puede estar asociada con el fenómeno de «wipe out». El objetivo de este estudio fue evaluar el resultado del tratamiento quirúrgico en el glaucoma avanzado. Métodos Este estudio retrospectivo incluyó 67 ojos de 49 pacientes con glaucoma en etapa terminal en los que se realizó una cirugía de glaucoma. Se revisaron los registros clínicos antes y después de la cirugía. El período de seguimiento fue de 14,4meses. Resultados a edad media fue de 50,2años y la proporción de sexos fue de 0,75. Todos los pacientes tenían un campo visual tubular con persistencia de una isla central. El valor medio de la desviación media en perimetría automatizada fue de 18,94dB±4,7. La presión intraocular (PIO) media antes de la cirugía fue de 27,16mmHg±8,9 Después de la operación la tasa de éxito general fue del 93% (PIO <18mmHg con agudeza visual estable). La PIO media fue de 14,25mmHg±4,12 (p<0,001). No hubo cambios significativos en la agudeza visual media. El valor medio de la desviación media fue de 18,83±4,69 (p=0,07). No se observó ningún fenómeno de wipe out. Las complicaciones postoperatorias tempranas fueron hipotonía, hifema e hipertonía y fueron transitorias, sin causar pérdida visual. Las complicaciones a largo plazo fueron la fibrosis tardía de la ampolla de filtración y la progresión de la catarata. Conclusión La cirugía de glaucoma tuvo efectos beneficiosos en la mayoría de los pacientes con glaucoma avanzado. La PIO postoperatoria estuvo en general controlada y la agudeza visual se preservó sin ningún caso de wipe out (AU)

Introduction There is uncertainty regarding the outcomes of glaucoma surgery for patients with advanced glaucoma, because it may be associated with the «wipe out» phenomenon.The aim of this study was to evaluate the outcome of surgical treatment in advanced glaucoma. Methods This retrospective study included 67eyes of 49 patients with end-stage glaucoma in which glaucoma surgery was carried out. The clinical records prior to and after surgery were reviewed. Follow up period was 14.4months. Result The mean age was 50.2years and the sex ratio was 0.75. All the patients had a tubular visual field with persistence of a central island. The mean value of the mean deviation on automated perimetry was 18.94dB±4.7. The mean intraocular pressure (IOP) before surgery was 27.16mmHg±8.9. Postoperatively the overall success rate was 93% (IOP <18mmHg with stable visual acuity). The mean IOP was 14.25mmHg±4.12 (P<.001). There was no significant change in the mean visual acuity. The mean value of the mean deviation was 18.83±4.69 (P=.07). No occurrence of wipe-out phenomenon was noted. The early postoperative complications were hypotony, hyphema and ocular hypertension and they were transient without causing any visual loss. Long term complications were late bleb fibrosis and progression of cataract. Conclusion Glaucoma surgery had beneficial effects in the majority of patients with advanced glaucoma. Postoperative IOP was in general under control and visual acuity was preserved without any cases of wipe-out (AU)

The outcome of surgical treatment in advanced glaucoma. / Evaluación de resultado del tratamiento quirúrgico en el glaucoma avanzado.

INTRODUCTION: There is uncertainty regarding the outcomes of glaucoma surgery for patients with advanced glaucoma, because it may be associated with the «wipe out¼ phenomenon. The aim of this study was to evaluate the outcome of surgical treatment in advanced glaucoma. METHODS: This retrospective study included 67eyes of 49 patients with end-stage glaucoma in which glaucoma surgery was carried out. The clinical records prior to and after surgery were reviewed. Follow up period was 14.4months. RESULTS: The mean age was 50.2years and the sex ratio was 0.75. All the patients had a tubular visual field with persistence of a central island. The mean value of the mean deviation on automated perimetry was 18.94dB±4.7. The mean intraocular pressure (IOP) before surgery was 27.16mmHg±8.9. Postoperatively the overall success rate was 93% (IOP <18mmHg with stable visual acuity). The mean IOP was 14.25mmHg±4.12 (P<.001). There was no significant change in the mean visual acuity. The mean value of the mean deviation was 18.83±4.69 (P=.07). No occurrence of wipe-out phenomenon was noted. The early postoperative complications were hypotony, hyphema and ocular hypertension and they were transient without causing any visual loss. Long term complications were late bleb fibrosis and progression of cataract. CONCLUSION: Glaucoma surgery had beneficial effects in the majority of patients with advanced glaucoma. Postoperative IOP was in general under control and visual acuity was preserved without any cases of wipe-out.

[Ocular manifestations of Behçet's disease]. / Les manifestations oculaires au cours de la maladie de Behçet.

INTRODUCTION: Behçet's disease is a systemic inflammatory disease. Ocular involvement is an important diagnostic criterion, and this disease may be associated with severe visual loss. PURPOSE: The goal of this study was to specify the epidemiological, clinical and therapeutic features of ocular involvement in patients with Behçet's disease and to identify risk factors for poor visual outcomes. METHODS: A retrospective study was performed in 93 patients diagnosed with ocular Behçet's disease over a period of 9 years. Epidemiological, clinical, and therapeutic data was obtained from medical records and analyzed retrospectively. Poor visual outcome was defined as visual acuity limited to light perception without projection or no light perception. RESULTS: The male:female ratio was 1.9. The mean age was 34.5 years. Ocular involvement was the presenting sign in 4%, bilateral in 61% and active in 68.8%. Uveitis was the most common presentation (57%), dominated by panuveitis, followed by retinal vasculitis (51.6%) and papilledema (10.7%). Maculopathy (26.8%) and cataract (18.2%) were the most common complications. Twenty patients (21.5%) had no light perception or light perception without projection. Treatment was based on corticosteroids in combination with immunosuppressive therapy (Azathioprine) in 55.9% of cases. Our study indicates a significant association of male gender and panuveitis with a poor visual outcome. CONCLUSION: Ocular involvement in Behçet's disease is frequent and serious, which may lead to blindness. Male gender and panuveitis were predictors of poor visual prognosis.