Comparison of combined phacoemulsification-non-penetrating deep sclerectomy and phacoemulsification-trabeculectomy

AIM: To compare the outcomes of combined phacoemulsification and non-penetrating deep sclerectomy(P-DS)with combined phacoemulsification and trabeculectomy(P-T)in patients who have cataract and moderate-to-severe primary open angle glaucoma(POAG)or pseudoexfoliative glaucoma(PXG).<p>METHODS: In this prospective randomized study 40 eyes of 40 patients with cataract and POAG or PXG were evaluated. Complete eye examination and glaucoma tests were performed in all patients. Combined P-DS and P-T were performed under local anesthesia in 20 eyes in each group. Visual acuity(VA), intraocular pressure(IOP)and number of glaucoma medications were all recorded preoperatively and postoperative on 10d, 1, 3, 6 and 12mo. Complications, laser goniopuncture in P-DS group and needling in P-T group were also recorded.<p>RESULTS: The age(P-DS, 66.3±11.0 and P-T, 70.2±9.3y)and sex distribution(P-DS, 7 female and 13 male, P-T, 9 female and 11 male)were similar in both groups(<i>P</i>>0.05). Number of POAG and PXG patients were 12 and 8, and 13 and 7 in P-DS and P-T groups, respectively(<i>P</i>>0.05). There was no difference between groups in terms of preoperative VA(P-DS, 0.69±0.22 and P-T, 0.76±0.22 logMAR), IOP(P-DS, 17.9±1.6 and P-T, 18.1±1.9 mm Hg)and number of medications(P-DS: 2.7±0.7 and P-T: 2.9±0.8),(<i>P</i>>0.05). VA increased, IOP and number of medications decreased in both groups postoperatively(<i>P</i><0.01). Postoperative IOPs were 15.0±1.7 and 14.5±1.6 mm Hg in P-DS and P-T groups respectively(<i>P</i>=0.472). Postoperative number of medications were slightly better in P-T group(0.5±0.7)than in P-DS group(0.8±0.9)(<i>P</i>=0.307). There were no complications in both groups. Laser goniopuncture was applied in 7 eyes(once in 5 eyes and twice in 2 eyes)in P-DS group. Needling was performed in 1 eye in P-T group. <p>CONCLUSION: In patients with coexisting cataract and glaucoma, both combined P-DS and P-T may be performed safely. Reliability and efficacy were similar in both groups. Follow-up of P-DS should be done cautiously and when necessary laser goniopuncture should be performed

Evaluation of Macular Thickness and Retinal Nerve Fiber Layer by Optical Coherence Tomography in Cases with Strabismic and Anisometropic Amblyopia

Pur po se: To measure the macular and retinal nerve fiber layer (RNFL) thicknesses using optical coherence tomography (OCT) in amblyopic eyes of unilateral strabismic and anisometropic patients and to compare the results with those of their normal eyes and with a control group. Ma te ri al and Met hod: 30 strabismic and 30 anisometropic amblyopic patients who were followed by Atatürk Training and Research Hospital Strabismus section between September 2009 and February 2010 and 30 healthy children who were examined in the out-patient clinic were included in the study. The amblyopic eyes of the amblyopic patients were compared with their normal eyes andwith the right eyes of the healthy patients. After detailed ophthalmologic examination, macular thickness, central foveal, parafoveal and perifoveal volumes and RNFL thickness of the cases were measured with OCT and compared statistically. A p-value of less than 0.05 was accepted as statistically significant. Re sults: Foveal volume of the amblyopic eyes of strabismic and anisometropic amblyopic cases (0.20mm3; 0.21mm3, respectively) was statistically higher than in the control group (0.19 mm3) (p=0.002).As the level of amblyopia increased, there was an increase in foveal volume. Central foveal thickness (CFT) of the amblyopic eyes of strabismic and amblyopic patients (258 μm and 260 μm, respectively) was higher than in the control group (244 μm), which was statistically significant difference (p=0.010). Similarly, as the level of amblyopia increased, there was an increase in CFT. When strabismic and amblyopic cases were compared, no statistical difference was observed between foveal volumes (central-parafoveal-perifoveal) and CFT results (p>0.05). There was no difference in RNFL thickness of strabismic, anisometropic and control cases (p>0.05). In addition, no significant difference was detected between the normal eyes of the amblyopic patients and the control group (p>0.05). Dis cus si on: Although the primary site of deficit is in the visual cortex in amblyopia, secondary changes occur in the retina as well. While RNFL thickness does not differ from that in normal eyes, the thickness and volume of the fovea of amblyopic eyes are higher than in normal individuals. As a result, amblyopia not only affects the visual cortex, but gives rise to secondary changes at retinal level. (Turk J Ophthalmol 2011; 41: 318-24