RESUMO
PURPOSE: To compare changes in anterior segment parameters following ExPRESS Mini Glaucoma Shunt surgery vs. trabeculectomy using the Pentacam rotating Scheimpflug camera. METHODS: In this prospective, comparative study, 27 patients with glaucoma treated at the Rabin Medical Center from 2009 to 2013 were enrolled in this prospective comparative study: 19 participants (19 eyes) underwent ExPRESS shunt implantation and 12 (13 eyes) underwent trabeculectomy. Changes in anterior chamber parameters at postoperative day 1 and postoperative month 3 were evaluated on Scheimpflug images. RESULTS: Intraocular pressure decreased significantly from baseline in both groups. The decrease in both groups was similar at postoperative month 3 (p=0.82). ExPRESS surgery caused a transient increase in posterior corneal astigmatism (p=0.008) and a transient decrease in anterior chamber depth (p=0.016) and volume (p=0.006) on postoperative day 1. At postoperative month 3, these parameters were no longer statistically significant (p=0.65, p=0.51, and p=0.57 respectively). Trabeculectomy caused a transient increase in anterior and posterior corneal astigmatism on postoperative day 1 (p=0.003 and p=0.005, respectively), which were not evident at postoperative month 3 (p=1.0 and p=1.0, respectively). At postoperative month 3, both ExPRESS and trabeculectomy showed similar changes in anterior chamber parameters. CONCLUSIONS: Both ExPRESS mini glaucoma implant and trabeculectomy significantly decreased intraocular pressure and had transient effects on anterior segment parameters, with minor differences between the methods.
Assuntos
Glaucoma , Trabeculectomia , Glaucoma/cirurgia , Humanos , Pressão Intraocular , Complicações Pós-Operatórias , Estudos Prospectivos , Tonometria Ocular , Trabeculectomia/efeitos adversosRESUMO
ABSTRACT Purpose: To compare changes in anterior segment parameters following ExPRESS Mini Glaucoma Shunt surgery vs. trabeculectomy using the Pentacam rotating Scheimpflug camera. Methods: In this prospective, comparative study, 27 patients with glaucoma treated at the Rabin Medical Center from 2009 to 2013 were enrolled in this prospective comparative study: 19 participants (19 eyes) underwent ExPRESS shunt implantation and 12 (13 eyes) underwent trabeculectomy. Changes in anterior chamber parameters at postoperative day 1 and postoperative month 3 were evaluated on Scheimpflug images. Results: Intraocular pressure decreased significantly from baseline in both groups. The decrease in both groups was similar at postoperative month 3 (p=0.82). ExPRESS surgery caused a transient increase in posterior corneal astigmatism (p=0.008) and a transient decrease in anterior chamber depth (p=0.016) and volume (p=0.006) on postoperative day 1. At postoperative month 3, these parameters were no longer statistically significant (p=0.65, p=0.51, and p=0.57 respectively). Trabeculectomy caused a transient increase in anterior and posterior corneal astigmatism on postoperative day 1 (p=0.003 and p=0.005, respectively), which were not evident at postoperative month 3 (p=1.0 and p=1.0, respectively). At postoperative month 3, both ExPRESS and trabeculectomy showed similar changes in anterior chamber parameters. Conclusions: Both ExPRESS mini glaucoma implant and trabeculectomy significantly decreased intraocular pressure and had transient effects on anterior segment parameters, with minor differences between the methods.
RESUMO Objetivo: Comparar as alterações nos parâmetros do segmento anterior após a cirurgia ExPRESS Mini Glaucoma Shunt vs. trabeculectomia usando a câmera Scheimpflug Pentacam rotativa. Métodos: Neste estudo comparativo prospectivo, 27 pacientes com glaucoma tratados no Centro Médico Rabin de 2009 a 2013 foram incluídos neste estudo comparativo prospectivo: 19 participantes (19 olhos) foram submetidos ao implante de derivação ExPRESS e 12 (13 olhos) foram submetidos à trabeculectomia. Alterações nos parâmetros da câmara anterior no dia 1 e em 3 meses de pós-operatório foram avaliadas pelas imagens de Scheimpflug. Resultados: A pressão intraocular diminuiu significativamente em relação aos valores iniciais nos dois grupos. A diminuição nos dois grupos foi semelhante no 3º mês pós-operatório (p=0,82). A cirurgia com ExPRESS causou um aumento temporário do astigmatismo posterior da córnea (p=0,008) e uma diminuição temporária da profundidade da câmara anterior (p=0,016) e do volume (p=0,006) no primeiro dia do pós-operatório. Ao final de três meses, esses parâmetros não foram mais estatisticamente significativos (p=0,065, p=0,51 e p=0,57, respectivamente). A trabeculectomia causou um aumento temporário do astigmatismo anterior e posterior da córnea no primeiro dia do pós-operatório (p=0,003 e p=0,005, respectivamente), mas isso não foi observado ao final de 3 meses (p=1,0 e p=1,0, respectivamente). Após 3 meses, tanto o EXPRESS quanto a trabeculectomia mostraram alterações semelhantes nos parâmetros da câmara anterior. Conclusões: O implante ExPRESS Mini para glaucoma e a trabeculectomia diminuíram significativamente a pressão intraocular e tiveram efeitos temporários nos parâmetros do segmento anterior, com pequenas diferenças entre os métodos.
Assuntos
Humanos , Trabeculectomia , Glaucoma , Complicações Pós-Operatórias , Tonometria Ocular , Trabeculectomia/efeitos adversos , Glaucoma/cirurgia , Estudos Prospectivos , Pressão IntraocularRESUMO
PURPOSE: To evaluate the induced ocular aberrations after cataract surgery with extreme low- powered and high-powered spherical monofocal intraocular lenses (IOLs) using a new pyramidal wavefront sensor aberrometer. SETTING: Vissum Instituto Oftalmológico, Alicante, Spain. DESIGN: Prospective observational comparative study. METHODS: This study included patients who had cataract surgery with implantation of a spherical monofocal IOL. The patients were divided into three groups according to the IOL power. Group 1: +20 diopters (D) to +23 D; Group 2: less than +10 D; and Group 3: +29 D or more. Assessment after 3 months included: uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, contrast sensitivity function test (Ginsburg), corneal aberrometry, and total ocular aberrometry with a pyramidal wavefront sensor aberrometer (Osiris) for 4.0 mm, 4.5 mm, and 5.0 mm pupil diameters. RESULTS: The study comprised 88 eyes of 56 patients. There were no differences between all groups in terms of refractive error, corneal aberrometry, or total ocular higher-order aberrations at any analyzed pupil diameter. The ocular spherical aberration (SA) was not significantly different between groups with a 4.0 mm pupil. The SA was significantly lower in Group 2 when compared with Group 1 and Group 3 for both 4.5 mm (P = .01 and P = .001, respectively) and 5.0 mm (P = .002 and P = .002, respectively). There was no significant difference in SA between Group 1 (+20 D to 23 D) and Group 3 (≥+29 D) at any analyzed pupil diameter. Higher SA did not correlate to lower contrast sensitivity. CONCLUSIONS: Despite the theoretical evidence, only a negligible amount of clinically insignificant aberrations were induced by high-powered positive IOLs. Low-powered IOLs did not induce significant levels of SAs.