Revista Brasileira de Oftalmologia (Aug 2010)
Comparação pressórica e visual entre a facoesclerectomia profunda não penetrante e a facotrabeculectomia Intraocular pressure and visual results from combined surgery: phacoemulsification with non penetrating deep sclerectomy and phacoemulsification with trabeculectomy
Abstract
OBJETIVO: O presente estudo tem como objetivo comparar os resultados do controle pressórico e acuidade visual (AV) entre a facoesclerectomia profunda não penetrante (FACOEPNP) e facotrabeculectomia (FACOTREC). MÉTODOS: Estudo observacional, retrospectivo através da revisão de prontuários. Foram selecionados 148 olhos de 127 pacientes submetidos à cirurgia no período de janeiro de 1998 a janeiro de 2007 do Instituto de Oftalmologia Tadeu Cvintal em portadores de glaucoma primário de ângulo aberto (GPAA) com diagnóstico de catarata coexistente. Destes pacientes 77 eram do sexo feminino, sendo que 49 (59%) foram submetidos à FACOEPNP e 28 (63,6%) foram submetidos à FACOTREC. Cinquenta pacientes eram do sexo masculino sendo, 34 (41%) submetidos à FACOEPNP e 16 (36,4%) a FACOTREC. O estudo teve duração de 12 meses e os pacientes tiveram pressão intraocular (PIO) (tonômetro de Goldmann) e AV (LogMar) aferidos no pré-operatório e um ano após o procedimento cirúrgico, além do número de medicações hipotensoras oculares que foram adicionados no pósoperatório. RESULTADOS: Os grupos se mostraram homogêneos quanto a AV pré (p = 0,067), AV pós (p = 0,924) e variação da AV (p = 0,099). A média de variação de AV no grupo FACOTREC foi de -0,31 (dp = 0,59) (p PURPOSE: the aim of the present study is to compare the intraocular pressure (IOP) and visual acuity (VA) after combined surgery: phacoemulsification with non penetrating deep sclerectomy and phacoemulsification with trabeculectomy. METHODS: this is an observacional and retrospective study by chart review. We selected 148 eyes from 127 patients from Tadeu Cvintal Ophthalmolgy Institute during January 1998 thru January 2007. All patients had primary angle glaucoma and cataract. Seventy seven patients were female, 49 (59%) had phacoemulsification with non penetrating deep sclerectomy and 28 (63,6%) had phacoemulsification with trabeculectomy. Fifty patients were male, 34 (41%) had phacoemulsification with non penetrating deep sclerectomy and 16 (36,4%) phacoemulsification with trabeculectomy. The patients had IOP (Goldmann) and VA (LogMar) measured before surgery and one year after surgery, also the number of glaucoma medications that patients had to drop after surgery. RESULTS: the groups were equals comparing VA before (p = 0,067), and after VA (p = 0,924) with variation VA (p = 0,099). The mean VA in the group that had phacoemulsification with trabeculectomy was 0,31 (dp = 0,59) (p < 0,0001), and the mean variation in the group that had phacoemulsification with non penetrating deep sclerectomy was -0,45 (dp 0,51) with p , 0,001. The IOP mean variation in the patients that had phacoemulsification with non penetrating deep sclerectomy -6,2 (dp = 5,1) had stastistically difference (p < 0,001) and the mean variation of IOP in the patients that underwent phacoemulsification with trabeculectomy was -6,6 (dp = 5,3) (p < 0,001). There was no statistically difference between the groups evaluating the glaucoma medications. CONCLUSION: non penetrating deep sclerectomy combined with phacoemulsification causes IOP reduction similar phacoemulsification with trabeculectomy with the same result evaluating VA.
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