Introduction: The combined phaco-sclerectomy supplanted
the phaco-trabeculectomy. With equivalent results on intraocular pressure, it
entails fewer complications. We present our experience.
Materials and
method: 55 eyes of 42
patients, including 17 women and 25 men, with both chronic glaucoma and cataract, were operated between June,
98 and May, 2000. The average age was of 77,5 years +/-10. The preoperative
intraocular pressure varied around 21 mmhg +/- 8,5 with a number of 2 or 3
glaucoma medications. The visual acuity before surgery did not overtake 20/63.
All the patients had a phaco-emulsification associated to a deep sclerectomy
under topical anaesthesia (Tetracaпne *)
Results: During the post-operative follow-up, the
pressure was of 15 mmHg. At least 96 % of the patients had an intraocular
pressure lower than 21 mmHg. The intraocular average pressure was 21 mmHg
under bi or tri - therapy before
surgery. Among these cases of normalization, 3 cases required the
reintroduction of glaucoma medications. In the early post-operative, we noted 3
choroidal detachments (effusion) by hypotony and 4 Neodymium:YAG laser
goniopunctures have been performed after micro-perforation. As for visual
outcomes, the average acuity was around 20/20 for an average of 20/63 in
preoperative.
Conclusion: Realized under topical anaesthesia in
ambulatory surgery, it represents a real comfort, for the surgeon as well as
for the patient. The deep sclerectomy is approachable but requires well trained
surgeons. The results after 2
years are stable but sometimes glaucoma medications are required.