9. FACOEMULSIFICAREA ÎN SINDROMUL PSEUDOEXFOLIATIV
AUTORI: C. ŞTEFAN, A. NENCIU, ALINA NEACŞU, G. ILIE, LUMINIŢ A DACHIN
CLINICA DE OFTALMOLOGIE - SPITALUL CLINIC DE URGENŢ Ă MILITAR CENTRAL
ADRESA PENTRU CORESPONDENŢ Ă - DR. ŞTEFAN CORNEL
CLINICA DE OFTALMOLOGIE - SPITALUL CLINIC DE URGENŢ Ă MILITAR CENTRAL
STR. MIRCEA VULCĂNESCU NR. 86-88, SECTOR 1, BUCUREŞTI
Tel.-Fax: 021 313 71 89, E-mail: milophtha@digicom.ro
REZUMAT
SCOP: Evaluarea comparativa a complicatiilor intraoperatorii si a rezultatelor postoperatorii in chirurgia cataractei prin facoemulsificare la pacienti cu şi fara sindrom pseudoexfoliativ (PEX).
MATERIAL SI METODA: Studiu clinic retrospectiv in perioada 01.01.2001-01.01.2004 (perioada medie de urmărire 21,5 luni) pe 116 de pacienti distribuiti in 2 loturi: lotul A (55 pacienti) cu cataractă senila si sindrom pseudoexfoliativ si lotul B (61 pacienti) cu cataracta senila fara sindrom pseudoexfoliativ.
Pacientii nu au prezentat alte afectiuni oftalmologice asociate, iar operatiile au fost realizate de acelasi chirurg. Au fost observate intraoperator: profunzimea camerei anterioare, diametrul pupilar, dehiscenta zonulara, rupturile capsulare, pierderile de vitros, iar postoperator (1zi, 1 saptamina, 1 lună si pina la 3 ani) au fost monitorizate: acuitatea vizuala, dinamica PIO, gradul inflamatiei, dislocarile pseudofakului. Prelucrarea statistica a fost realizata prin testul t - Student.
REZULTATE: Au fost stabilite corelatii statistic semnificative intre diametrul pupilar maxim, profunzimea < 2,5 mm a CA si incidenta complicatiilor intraoperatorii in lotul A. AV a prezentat valori similare in ambele loturi, iar dinamica PIO a relevat degajarea presională mai importanta in lotul A, dar fara diferente statistic semnificative fată de grupul martor. Pe termen lung, cristalinele artificiale cu diametrul optic mai mare au fost mai stabile.
CONCLUZII: Facoemulsificarea reprezinta o metoda sigura in chirurgia cataractei la pacientii cu sindrom pseudoexfoliativ in conditiile respectarii unui protocol preoperator standardizat : dilatare maxima, capsulorexis continuu, rotund, hidrodisectie totala. Pe termen lung, fiind avizati asupra posibilelor complicatii, se pot obtine rezultate postoperatorii comparative cu cele realizate la pacienti fara sindrom pseudoexfoliativ.
CUVINTE CHEIE:
Inapoi Sumar Precedentul Urmatorul
ABSTRACT
PURPOSE: To compare the results and the complications of cataract surgery by phacoemulsification in eyes with pseudoexfoliation syndrome (PEX) and without pseudoexfoliation syndrome.
METHODS: A retrospective clinical study (January 2001 - January 2004; mean follow-up 21,5 months) of 116 cases divided in two groups: group A (55 eyes) with senile cataract and pseudoexfoliation syndrome and group B (61 eyes) with senile cataract but without pseudoexfoliation syndrome. The eyes were without another associated ophthalmological diseases and the phacoemulsifications were performed by the same surgeon. Intraoperative observations included anterior chamber depth, pupil size after maximal mydriasis, zonular dehiscence, capsule tear, vitreous loss and postoperatively: best corrected visual acuity, intraocular pressure (IOP), aqueous flare response and IOL stability were evaluated at 1 day, 1 week, 1 month and until 3 years. The Student-t test was used for statistical analyses.
RESULTS: There were determined significant correlations between pupil size, anterior chamber depth and the rate of complications in the group A. The visual acuities were similar in both groups. IOP reduction was superior in the eyes with PEX as compared with control group, but without statistically significantly difference. In group A, there were a non-statistically significantly percentage of IOL dislocation as compared with group B. In the eyes with PEX, it is neccesary to utilize IOLs with bigger optic size.
CONCLUSIONS: Phacoemulsification represents a safe method in cataract surgery in eyes with pseudoexfoliation syndrome in the presence of careful surgical technique: maximal mydriasis, circular continuous curvilinear capsulorhexis, adequate hydrodissection. On the long run, the postoperative results were comparable between eyes with PEX and the control group (without PEX).
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