.: OKULISTYKA :.

Wydanie 3/2010
str. 72

Wpływ fakoemulsyfikacji zaćmy na parametry metryczne komory przedniej oraz ciśnienie wewnątrzgałkowe w oczach z jaskrą

The Influence of Phacoemulsification on Anterior Chamber Depth and Angle Width in Eyes with Glaucoma

Joanna Konopińska, Katarzyna J. Napora, Zofia Mariak

Klinika Okulistyki Uniwersytetu Medycznego w Białymstoku
Kierownik: prof. dr hab. n. med. Zofia Mariak

Summary: Objective: To evaluate quantitatively changes in the anterior chamber depth (ACD), angle width (AW) and intraocular pressure induced by phacoemulsification and intraocular lens (IOL) implantation in eyes with glaucoma using ultrasoundbiomicroscopy (UBM).
Participants and Methods: Foreword prospective study of 84 emmetropic eyes from 84 patients divided into two groups. Group I counted 49 eyes with open-angle glaucoma (Ia, n = 36) and angle-closure glaucoma (Ib, n = 13) underwent phacoemulsification and IOL implantation, group II – 25 control eyes of 25 age-matched patients scheduled for phacoemulsiﬁcation surgery. Additionally 10 healthy eyes were examined to determine normal biometric parameters. All surgical procedures were performed by the same, highly qualified surgeon; all implanted lenses were the same kind. The participants were 35 men and 49 women aged average 77.58 ± 6.99, ranging from 61 to 90, hospitalized in the Department of Ophthalmology Medical University of Bialystok. The main diagnostic tests included measuring refraction, applanation tonometry, keratometry, pachymetry, gonioscopy, ophthalmoscopy, and anterior chamber depth and angle width using UBM (Vu-max I, Sonomed). The examination was performed by the same person, in standardized conditions using Siemens 35 Hz head.
Results: In both groups ACD and AW increased after surgery (p<0.05). In healthy eyes – ACD = 2.88 ± 0.44 mm, AW = 34.98 ± 9.12° in comparison to: group Ia – ACD = 2.29 ± 0.4 mm, AW = 37.27 ± 10.55°; group Ib – ACD = 1.68 ± 0.25 mm, AW = 24.38 ± 10.9°; group II – ACD = 2.97 ± 0.72 mm, AW = 38.43 ± 9.43°. One month after surgery in group Ia: ACD = 3.68 ± 0.4 mm, AW = 49.64 ± 10.47° (p<0.05); after 6 months: ACD = 3.79 ± 0.41 mm, AW = 51.25 ± 9.73° (p>0.05); one year later: ACD = 3.84 ± 0.39 mm, AW = 55.12 ± 12.09° (p<0.05). One month after phacoemulsification in group Ib: ACD = 3.65 ± 0.4 mm, AW = 45.64 ± 16.04° (p<0.05); after 6 months: ACD = 3.74 ± 0.3 mm, AW = 38.84 ± 12.13° (P>0.05); one year after: ACD = 3.75 ± 0.29 mm, AW = 40.86 ± 9.15°. The mean outcome measures in group II – one month after surgery: ACD = 3.55 ± 0.48 mm, AW = 51.29 ± 8.31°; after half a year: ACD = 3.68 ± 0.48 mm, AW = 53.11 ± 7.1°; one year after: ACD = 3.63 ± 0.31 mm, AW = 52.47 ± 9.21°.
After phacoemulsification the mean IOP declined in all groups. In group Ia from 17.92 ± 3.76 mmHg before surgery decrease to 15.3 ± 3.1 mmHg, by the average of 2.65 mmHg in first month. After six months it counted 14.79 ± 2.74 mmHg, and 14.98 ± 2.16 mmHg one year after surgery. The mean IOP in group Ib declined from 19.23 ± 6.72 mmHg before surgery to 15.16 ± 5.41 mmHg in first month, after six months it counted 14.5 ± 2.89 mmHg, and 14.12 ± 0.76 mmHg one year after surgery. In group II the mean IOP before phacoemulsification was 15.2 ± 2.81 mm, and dropped to 13.2 ± 3.1 mmHg; 14.1 ± 2.5 mmHg; 14.33 ± 2.7 mmHg during next control tests.
Conclusions: The width of the angle, and the depth of the anterior chamber in eyes with glaucoma increased significantly after cataract extraction and IOL implantation. This effect is followed by the decrease in IOP in the postoperative period by an average of 2.16 in open angle glaucoma and 5.11 in angle closure glaucoma. This effect is permanent for at least one year after phacoemulsification. The study is still continued and will be verified with wider clinical material and control groups.

Słowa kluczowe: jaskra, głębokość komory przedniej, szerokość kąta przesączania.

Keywords: glaucoma, anterior chamber depth, angle width.

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