KATARAKTI VE PRİMER AÇIK AÇILI GLOKOMU OLAN HASTALARDA FAKOEMÜLSİFİKASYON CERRAHİSİNİN, GÖZ İÇİ BASINCI VE ANTERİOR SEGMENT ANATOMİSİ ÜZERİNDEKİ ETKİSİ

Öz

Amaç: Kataraktı ve primer açık açılı glokomu (PAAG) olan hastalarda fakoemülsifikasyon cerrahisinin, göz içi basıncı (GİB), ön kamara derinliği (ÖKD), iridokorneal açı (İKA) ve merkezi kornea kalınlığı (MKK) üzerindeki etkisini değerlendirmek.

Gereç ve Yöntemler: Fakoemülsifikasyon ve intraoküler lens (IOL) implantasyonu cerrahisi geçiren, kataraktı ve PAAG’u olan 97  hastanın 97 gözü retrospektif olarak incelendi. Preoperatif ve postoperatif  1.hafta, 1. ay, 3. ay, 6. ay, 1. yıl ve 2. yıl GİB, ÖKD, İKA ve MKK ölçümleri alındı.

Bulgular: Preoperatif ortalama GİB değeri 17.76 ±2.52 (SD) (14-21) mmHg idi. Postoperatif 1.hafta, 1. ay, 3. ay , 6. ay ve 1. yıl GİB değerlerindeki düşüş istatistiksel olarak anlamlı idi, ancak postoperatif  2.yıl GİB değerindeki değişiklik anlamlı değildi (p değerleri sırasıyla, 0.00, 0.00, 0.00, 0.00, 0.03 ve 0.07). Preoperatif ortalama ÖKD değeri 2.91±0.35 (SD) (2.4 - 3.6) mm idi. Postoperatif 1.hafta, 1. ay, 3. ay, 6.ay ve 1.yıl  ÖKD değerlerindeki artış istatistiksel olarak anlamlıydı, ancak postoperatif 2.yıl ÖKD değerindeki değişiklik anlamlı değildi (p değerleri sırasıyla, 0.00, 0.00, 0.00, 0.01, 0.03 ve 0.07). Preoperatif ortalama İKA derecesi 2.88 ±0.69 (SD) (2 - 4) (Shaffer  Klasifikasyonu) idi. Postoperatif 1.hafta, 1.ay, 3.ay, 6.ay ve 1.yıl  İKA derecelerindeki artış istatistiksel olarak anlamlıydı, ancak postoperatif 2.yıl İKA derecesindeki değişiklik anlamlı değildi (p değerleri sırasıyla, 0.00, 0.00, 0.00, 0.01, 0.04 ve 0.56). Preoperatif ortalama MKK değeri 536.12 ±  21.23 (SD) (515-589) µm idi. Postoperatif 1.hafta ve 1.ay MKK değerlerindeki artışlar istatistiksel olarak anlamlıydı, ancak postoperatif  3.ay, 6.ay, 1.yıl ve 2.yıl MKK değerlerindeki değişimler anlamlı değildi (p değerleri sırasıyla, 0.00, 0.00, 0.10, 0.28, 0.84 ve 0.87).

Sonuç:  Fakoemülsifikasyon cerrahisi kısa dönemde GİB’nı azaltmaktadır, ÖKD  ve İKA derecesini artırmaktadır. Ancak  uzun dönemde anlamlı bir değişikliğe sebep olmamaktadır.

Anahtar Kelimeler

• Fakoemülsifikasyon,Göz içi basıncı,Katarakt

Kaynakça

1. 1. Hayashi K, Hayashi H, Nakao F,Hayashi F. Changes in anterior chamber angle width and depth after intraocular lens implantation in eyes with glaucoma. Ophthalmology 2000; 107: 698-7032. Cimetta DJ, Cimetta AC. Intraocular pressure changes after clear corneal phacoemulsification in nonglaucomatous pseudoexfoliation syndrome. Eur J Ophthalmol 2008; 18: 77-813. Shrivastava A, Singh K. The effect of cataract extraction on intraocular pressure. Curr Opin Ophthalmol 2010; 21:118-224. Walland MJ, Parikh RS, Thomas R. There is insufficent evidence to recommend lens extraction as a treatment for primary open-angle glaucoma: an evidence based perspective. Clin Experiment Ophthalmol 2012; 40:400-75. Dayanir V, Ozdemir A, Kaplan A, Kırıkkaya E. Impact of phacoemulsification surgery on intraocular pressure in primary angle-closure glaucoma. Turk J Ophthalmol 2012; 42:438-426. Uçakhan OO, Ozkan M, Kanpolat A. Anterior chamber parameters measured by Pentacam CES after uneventful phacoemulsification in normotensive eyes. Acta Ophthalmol 2009; 87:544-87. Mathalone N, Hyams M, Neiman S, Buckman G, Hod Y, Geyer O. Long-term intraocular pressure control after clear corneal phacoemulsification in glaucoma patients. J Cataract Refract Surg 2005; 31:479-838. Ismi T, Yilmaz A. Effects of cataract surgery on intraocular pressure in patients with and without glaucoma. Turk J Ophthalmol 2013;43:167-729. Gonen T,Keskinbora K,Horozoglu F,Sever O,Yasar M. Effect of anterior chamber depth on intraocular pressure after uneventful phacoemulsification surgery in nonglaucomatous eyes with cataract. Turk J Ophthalmol 2011;41:207-1210. Shrivastava A, Singh K. The impact of cataract surgery on glaucoma care. Curr Opin Ophthalmol 2014; 25:19-2511. Shin HC, Subrayan V, Tajunisah I. Changes in anterior chamber depth and intraocular pressure after phacoemulsification in eyes with occludable angles. J Cataract Refract Surg 2010; 36:1289-95
2. 12. Nolan WP, See JL, Aung T, Friedman DS,Chan YH,Smith SD, et al. Changes in angle configuration after phacoemulsification measured by anterior segment optical coherence tomography . J Glaucoma 2008; 17:455-913. Lam DS, Tham CC, , Lai JS, Leung DY. Current approaches to the management of acute primary angle closure. Curr Opin Ophthalmol 2007; 18:146-5114. Zhuo YH, Wang M, Li Y, Hao YT,Lin MK,Fang M, et al. Phacoemulsification treatment of subjects with acute primary angle-closure and chronic primary angle-closure glaucoma. J Glaucoma 2009; 18:646-5115. Mansberger SL, Gordon MO, Jampel H, Bhorade A, Brandt JD, Wilson B, et al. Ocular Hypertensin Treatment Study Group. Reduction in intraocular pressure after cataract extraction : the ocular hypertension treatment study. Ophthalmology 2012; 119:1826-3116. Huang G, Gonzalez E, Peng PH, Lee R, Leeungurasatien T, He M, et al. Anterior chamber depth, iridocorneal angle width and intraocular pressure changes after phacoemulsification : narrow vs open iridocorneal angles. Arch Ophthalmol 2011; 129:1283-9017. Nonaka A, Kondo T, Kikuchi M, Yamashiro K, Fujihara M, Iwawaki T, et al. Angle widening and alteration of ciliary process configuration after cataract surgery for primary angle closure. Ophthalmology 2006; 113:437-4118. Chang TC, Budenz DL, Liu A, Kim WI, Dang T, Li C, et al. Long-term effect of phacoemulsification on intraocular pressure using phakic fellow eye as control. J Cataract Refract Surg 2012; 38:866-7019. Slabaugh MA, Bojikian KD, Moore DB, Chen PP. The effect of phacoemulsification on intraocular pressure in medically controlled open-angle glaucoma patients. Am J Ophthalmol 2014; 157:26-3120. Poley BY, Lindstrom RL, Samuelson TW. Long-term effects of phacoemulsification with intraocular lens implantation in normotensive and ocular hypertensive eyes. J Cataract Refract Surg 2008; 34:735-4221. Poley BY, Lindstrom RL, Samuelson TW, Schulze R Jr. Intraocular pressure reduction after phacoemulsification with intraocular lens implantation in glaucomatous and nonglaucomataus eyes : evaluation of a causal relationship between the natural lens and open-angle glaucoma. J Cataract Refract Surg 2009; 35:1946-5522. Merkur A, Damji KF, Mintsioulis G, Hodge WG. Intraocular pressure decrease after phacoemulsification in patients with pseudoexfoliation syndrome. J Cataract Refract Surg 2001; 27:528-3223. Damji KF, Konstas AG, Liebmann JM, Hodge WG, Ziakas NG, Giannikakis S, et al. Intraocular pressure following phacoemulsification in patients with and without exfoliation syndrome: a 2 year prospective study. Br J Ophthalmol 2006; 90:1014-1824. Shingleton BJ, Laul A, Nagao K, Wolff B, O’Donoghue M, Eagan E, et al. Effect of phacoemulsification on intraocular pressure in eyes with pseudoexfoliation: single-surgeon series. J Cataract Refract Surg 2008; 34:1834-4125. Shingleton BJ, Heltzer J, O’Donoghue MW. Outcomes of phacoemulsification in patients with and without pseudoexfoliation syndrome. J Cataract Refract Surg 2003; 29:1080-8626. Baek SU, Kwon S, Park IW, Suh W. Effect of Phacoemulsification on Intraocular Pressure in Healthy Subjects and Glaucoma Patients. J Korean Med Sci 2019;34(6):e47.27. Kim JH, Rabiolo A, Morales F, Fatehi N, Lee WS, Yu F, et al. Cataract Surgery and Rate of Visual Field Progression in Primary Open-Angle Glaucoma. Am J Ophthalmol 2019; S0002-9394 (19) 30040-6.28. Chelerkar V , Parekh P , Kalyani VKS , Deshpande M , Khandekar R.Comparative Clinical Study of Medically Controlled Nonsevere Chronic Primary Angle-closure Glaucoma with Coexisting Cataract Surgically Managed by Phacoemulsification as against Combined Phacotrabeculectomy. Middle East Afr J Ophthalmol. 2018;25(3-4):119-25.29. Selvan H , Angmo D, Tomar AS, Yadav S, Sharma A, Dada T.Changes in Intraocular Pressure and Angle Status After Phacoemulsification in Primary Angle Closure Hypertension. J Glaucoma. 2019;28(2):105-10.