RESUMO
Objetivo: Evaluar la eficacia de la esclerectomía profunda no perforante (EPNP) en el control de la presión intraocular (PIO) en el glaucoma de ángulo abierto. Material y Método: Estudio retrospectivo consistente en revisión de fichas clínicas de 62 pacientes operados (70 ojos) desde enero de 1999 a diciembre de 2002. Resultados: PIO promedio preoperatoria fue de 25,43 mmHg. El 65,87 por ciento de los pacientes usaban 2 medicamentos antes de la cirugía y el 29,85 por ciento usaba 3 ó más. La PIO promedio postoperatoria inmediata fue de 10,81 mmHg. El promedio de PIO a 2 años de seguimiento fue de 17,83 mmHg. El 61 por ciento de los pacientes no usaban o sólo usaban 1 medicamento para control de la PIO. No se observaron complicaciones severa. El 30 por ciento de los pacientes presentaron alteración de la vesícula de filtración. Conclusión: EPNP debe considerarse una herramienta útil y eficaz en el manejo de los pacientes con glaucoma de ángulo abierto, ya que disminuye significativamente la PIO y la necesidad de tratamiento farmacológico tópico. La técnica quirúrgica tiene una baja incidencia de complicaciones, tanto intra como postoperatorias. La mayoría de ellas asociada a alteraciones de la vesícula de filtración.
Assuntos
Humanos , Esclera/cirurgia , Esclerostomia/métodos , Glaucoma de Ângulo Aberto/cirurgia , Pressão Intraocular , Chile , Doença Crônica , Seguimentos , Complicações Intraoperatórias , Complicações Pós-Operatórias , Cuidados Pré-Operatórios , Estudos RetrospectivosRESUMO
PURPOSE: Since 1998 we have been conducting a prospective study of nonpenetrating deep trabeculectomy with chronic open-angle glaucoma to evaluate the efficiency of the technique. MATERIAL AND METHODS: The study was carried out in 55 eyes of 41 patients who suffered from open-angle glaucoma. After performing a superior scleral flap, mitomycin diluted to 0.01% was applied for 3 minutes, then the 4 x 4-mm superficial scleral flap was dissected at two-thirds deepness until reaching the cornea. The Schlemm canal and the external trabecula were surgically removed and the two points of the Schlemm canal were catheterized with a trabeculotome to ensure that the ablation was well done. If it was not, it was completed by using a trabeculotome as a guide. Postoperatively, if the filtering bleb tended to decrease or ocular pressure began to increase, the operated trabecular region was reopened with Yag laser. The filtering bleb characteristics were correlated with the normalization of intraocular pressure in the first 30 cases. RESULTS: Preoperative pressure without treatment was 32 mmHg. Postoperative intraocular pressure without treatment was 20 mmHg or less in 79% of the eyes after 4 months, 77.5% after 6 months, 75% after 8 months and 61% after 12 months. By adding a local hypotension treatment in monotherapy, a pressure of 20 mmHg or less was obtained in 79% of the cases after 12 months. No severe complications were observed. The presence of a filtering bleb is an important factor in the normalization of postoperative pressure (p=0.0048). CONCLUSIONS: This surgical technique provides a substantial decrease in intraocular pressure and very few complications after 12 months of follow-up.