MODERN CAPABILITIES OF SURGICAL MANAGEMENT OF PATIENTS WITH OPEN-ANGLE GLAUCOMA COMBINED WITH CATARACT

Cataract and glaucoma affecting mainly elderly people sometimes are associated; therefore the problem of their combined treatment is urgent. The aim of the investigation was to assess the efficiency of modern surgery in patients with combined cataract and open-angle glaucoma. Materials and Methods. The present open prospective study is based on the examination and surgery findings of patients with associated cataract and different stages of open-angle glaucoma (200 eyes). Depending on surgery type patients were divided into three groups. Group 1 included 81 patients (100 eyes) with combined cataract and glaucoma stabilized by medical treatment, who underwent phacoemulsification with intraocular lens implantation. Group 2 consisted of 44 patients (50 eyes) with cataract associated with open-angle glaucoma, who underwent phacoemulsification with intraocular lens implantation in combination with sinusotomy with viscocanalodilatation. 44 patients (50 eyes) with associated cataract and glaucoma, in whom phacotrabeculectomy was performed, composed group 3. Most patients had developed and advanced stages of glaucoma (81%). In addition, in the majority of patients the pseudoexfoliation syndrome (71.5%) was found. Results. Phacotrabeculectomy and phacoemulsification with viscocanalodilatation were found to have a marked hypotensive effect in significant improvement of visual function in patients with associated cataract and glaucoma, regardless of glaucoma stage and pseudoexfoliation syndrome presence. Moreover, phacoemulsification with sinusotomy and viscocanalodilatation provides earlier visual acuity recovery with less early postoperative complications compared to phacotrabeculectomy, and hypotensive effect is comparable to phacotrabeculectomy after additional laser goniopuncture which was required postoperatively in 58% cases. Phacoemulsification, being a less traumatic procedure, causes less postoperative complications in patients with associated cataract and glaucoma, however, a hypotensive effect is sufficient only with additional medical therapy.