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Aim. A clinical analysis of the efficacy of eliminating the risk of acute glaucoma attack by performing preventive minimally invasive cataract surgery in patients at such a risk.Materials and methods. In total, 70 eyes with a short anteroposterior axis and a thickened lens shape, and an increased risk of acute glaucoma attack were investigated. The main group included 45 patients subjected to preventive phacoemulsification (PE), and the reference group included 25 patients not subjected to PE. According to the position of the ciliary body (middle and posterior), each group was divided into two subgroups. The parameters of lens cross-sectional area (CSA) and anterior chamber cross-sectional area (ACCSA) were studied using B-scan ultrasonography of the anterior eye segment.Results. On the 2–3rd day after PE, the main group showed an increase in the anterior chamber depth and ACCSA values, along with an opening of the anterior chamber angle (ACA) to grade 3. These indicators remained at the same level by the end of the 4–5 year observation period. After 1–3 years, the reference group demonstrated a statistically significant decrease in the anterior chamber depth and ACCSA values, a narrowing of the ACA width, as well as an increase in intraocular pressure. After 4–5 years, the ACA was completely closed (0°), and the CSA indicator significantly increased.Conclusion. Immediately after preventive surgery, all patients of the main group showed a statistically significant improvement in the studied parameters, which remained stable following the period of 4–5 years.
Aim. A clinical analysis of the efficacy of eliminating the risk of acute glaucoma attack by performing preventive minimally invasive cataract surgery in patients at such a risk.Materials and methods. In total, 70 eyes with a short anteroposterior axis and a thickened lens shape, and an increased risk of acute glaucoma attack were investigated. The main group included 45 patients subjected to preventive phacoemulsification (PE), and the reference group included 25 patients not subjected to PE. According to the position of the ciliary body (middle and posterior), each group was divided into two subgroups. The parameters of lens cross-sectional area (CSA) and anterior chamber cross-sectional area (ACCSA) were studied using B-scan ultrasonography of the anterior eye segment.Results. On the 2–3rd day after PE, the main group showed an increase in the anterior chamber depth and ACCSA values, along with an opening of the anterior chamber angle (ACA) to grade 3. These indicators remained at the same level by the end of the 4–5 year observation period. After 1–3 years, the reference group demonstrated a statistically significant decrease in the anterior chamber depth and ACCSA values, a narrowing of the ACA width, as well as an increase in intraocular pressure. After 4–5 years, the ACA was completely closed (0°), and the CSA indicator significantly increased.Conclusion. Immediately after preventive surgery, all patients of the main group showed a statistically significant improvement in the studied parameters, which remained stable following the period of 4–5 years.
According to the results of various studies, in up to 50% cases after cataract phacoemulsification patients with glaucoma experience ophthalmic hypertension on the first day. This occurs due to the mechanical retention of aqueous humor in the anterior chamber. Temporary decrease in the function of the eye drainage system is explained by pigment particles, viscoelastic, erythrocytes, protein cells, product of postoperative inflammation and lens particles obstructing the trabecula. In the long-term period after phacoemulsification in glaucoma patients there is a decrease in the intraocular pressure in up to 74% of cases.A decrease in the density of endothelial cells in these patients occurs as a result of fluctuation of intraocular pressure, prolonged application of hypotensive drops, surgical intervention and presence of drainage devices after antiglaucoma surgery. This leads to the increase of inflammatory reaction of the cornea in the form of edema of up to 16.9% after cataract phacoemulsification.Phacoemulsification also provides a significant hypotensive effect (up to 34%) and is a preventive measure for an acute attack in patients with angle-closure glaucoma. However, the state of acute glaucoma attack leads to difficulties in phacoemulsification in the form of high intraocular pressure, corneal edema and small chamber. Cataract extraction under such circumstances causes an increase in postoperative corneal edema and eye inflammation of up to 22.85%.
PURPOSE. To determine the age-related increase in lens thickness (LT), decrease in anterior chamber depth (ACD) and anterior chamber angle (ACA) in patients with short axial length (APA) of the eyes.METHODS. The study included 100 patients (200 eyes) with short AL (23 mm or less), with a transparent lens or with initial stage of age-related cataract: 46 men and 54 women, aged 19 to 85 years. The LT and ACD, ACA parameters were assessed using optical coherence tomography.RESULTS. In the total population of patients, LT increased by an average of 32 μm per year. At the same time, ACD and ACA decreased by an average of 14 µm and 0.3° per year, respectively (p<0.001). In men, LT increased by 35 μm per year, while in women it increased by 29 μm per year, the difference was not statistically significant (p=0.071). But the decrease in ACA in men averaged 0.38° per year, while in women it was 0.23° per year, this difference was statistically significant (p=0.003). In addition, the rate of decrease in the ACD in men and women also differed statistically significantly: 18 µm versus 11 µm per year (p=0.018).CONCLUSION. 1. According to our data, the annual increase in LT in eyes with short AL averages 32 μm, the decrease in ACD and ACA is on average 14 μm and 0.3° per year, respectively.2. We did not find a statistically significant gender difference in the rate of annual increase in LT, although the rate of decrease in ACA and ACD in men turned out to be statistically significantly higher.3. The obtained data on the annual changes in such morphometric parameters as LT, ACA and ACD in eyes with short AL are key in the formation of primary angle-closure glaucoma (PACG). It may allow a more precise prediction of the timeline of an increased risk of PACG in each particular case.
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