Nonpenetrating laser sclerotomy before cataract phacoemulsification Maria Yugay

Non-penetrating laser sclerotomy before cataract phacoemulsification Maria Yugay, Elena Chomyakova, Alla Ryabtseva, Moscow Regional Research Clinical Institute, Moscow, Russia Purpose: It is described in literature that after lens removal IOP reduces 2 to 5 mm Hg. Some ophthalmologists offer phacoemulsification as a treatment for angle-closure glaucoma. Phacoemulsification is generally considered as hypotensive procedure. On the contrary, there is also abundant evidence of IOP increase in the early period after phaco, accompanied by pain and corneal oedema. Reactive syndrome and reactive hypertension after cataract phacoemulsification is a serious complication. For its prevention in patients with risk factors (short axial length, increased intraocular pressure, dense nucleus) non-penetrating laser sclerotomy was performed up to 1 day before the surgery. f Methods: 30 patients aged 55 -78 years old, 17 women, 13 men were operated on. Mean axial length was 22, 5± 0, 2 mm, mean IOP 22, 4± 1, 4 mm. Hg. Sclera was exposed to Nd: YAG laser at wave length 1064 nm in packets of 2 -3 pulses supplied in a quasicontinuous mode at pulse power 4 -7 m. J. A target beam was focused on an avascular area of the sclera with the laser focus displaced forward from a target point. An upper semi-sphere at 3 -4 mm from the limb was covered with 5 -7 lines of 70 -90 non- penetrating transconjunctival applications each. A required quantity of nonpenetrating transconjunctival applications was used in a lower semi-sphere. Phacoemulsification with IOL implantation was performed the next day. In all cases Ocular Response Analyser was used to measure Corneal-compensated IOP, Goldman IOP and corneal hysteresis. Сontrol group consisted of 30 patients of similar age, axial length and IOP, who underwent phacoemulsification without preliminary laser sclerotomy. Results: In the control group on the first day after surgery IOPcc increased by 2, 84 mm Hg, and IOPg by 1, 53 mm. Hg in comparison with preoperative values. Two weeks after surgery IOPcc further increased by 0, 62 mm. Hg, IOPg by 1, 44 mm. Hg. IOP increase in the early postoperative period may be caused by reactive syndrome with ocular hypertension. Despite of advances in surgical techniques, traumatisation of tissues , especially iris, can not be excluded. Viscoelastics and corticosteroids also play their role. In 1 month IOPcc returned to preoperative values, IOPg decreased by 1, 0 mm. Hg compared with the preoperative index. After 3 months inflammatory changes subsided and IOPcc decreased compared with the preoperative level by 1, 51 mm Hg, and IOPg by 1, 92 mm. Hg. After the laser sclerotomy cornealcompensated IOP and Goldmann IOP decreased by 2 -3 mm Hg, corneal hysteresis increased slightly. Phacoemulsification was uneventful in all cases. There was no IOP increase after phacoemulsification in patients with risk factors. UBM of anterior segment of the eye before and after cataract phacoemulsification. Topographic changes lead to increase of aqueous outflow. Conclusions: 1. Cataract phacoemulcification with IOL implantation correlated with changes in intraocular pressure. During first two weeks after phaco IOP increased by 33, 5 mm Hg. The rise in IOP was detected on the first postoperative day, reached maximum after 2 weeks, then by the end of the first month after surgery tonometric IOP returned to the preoperative values. 2. Decrease of tonometric IOP began 1 month after surgery. IOP reduction was 1, 5 -2 mm Hg according to the Ocular Response Analyzer. 3. Non-penetrating laser sclerotomy can be used as a means of preventing hypertension after phacosurgery. Method enables reaching the graduated drug -free minimally invasive intraocular pressure reduction. Ocular response analyser IOPg – Goldmann IOP, IOPcc – corneal compensated IOP Corneal compensated IOP, mm Hg after laser sclerotomy control group (without laser sclerotomy) 18. 71 Laser applications in the sclera Lines of laser applications around limbus 18. 76 17. 95 17. 86 17. 92 15. 92 19. 38 15. 91 14. 39 15. 75 before after phaco 2 weeks after phaco 1 month after phaco 3 months after phaco References. 1. Fayzieva U. S. et. al. Evaluating the efficiency of phacoemulsification in normalizing IOP in primary angle-closure glaucoma. Modern technologies of cataract and refractive surgery. 2009: 416 -18. (in Russian) 2. Zolotarev A. V. , Stebneva I. G. , Karlova E. V. , Pavlova O. V. Hypotensive effect of phacoemulsification and postoperative clinical refraction: is there a relationship? Materials of the VIII All-Russian scientific and practical conference with international participation Fedorov readings. 2009: 118 -120. (in Russian) 3. Suzuki R, Tanaka K. Sagara T, Fujiwara N. Reduction of intraocular pressure after phacoemulsification and aspiration with intraocular lens implantation. Ophthalmologica. 1994; 208: 254 -25. 4. Anmad ZJ, Kashif I. , Fawad UR, Khuram AM Effect of phacoemulsification on intraocular pressure. Journal of the College of Physitians and Surgeons Pakistan. 2011, 21: 347 -350. 5. Arutyunyan I. A. Reactive hypertension after cataract phacoemulsification and methods of its treatment. Dr. med. sci. diss. Moscow; 2006 (in Russian). 6. Koretskaya Y. M. , Mozherenkov V. P. , Ryabtseva A. A. Postoperative hypertension syndrome. In: Problems of the pathogenesis and treatment of glaucoma. Moscow, 1981; 99 -101 (in Russian). 7. Ryabtseva A. A. Reactive hypertension after cataract extraction. Dr. med. sci. diss. Moscow; 1987. (in Russian). 8. Bomer TG, Lagrese WD, Funf J. Intraocular pressure rise after phacoemulsification with posterior chamber lens implantation: effect of prophylactic medication, wound closure, and surgeon`s experience. British Journal of Ophthalmology. 1995; 79: 809 -813. 9. Coban-Karatas M. , Sizmas S, Altan-Yayciogly R. et al. Risk factors for intraocular pressure rise following phacoemulsification. Indian. J. Ophthalmol. 2013, 61: 115 -118. 10. Pohjalainen T. , Vesti E. , Uusitalo RJ, Laatikainen L. Intraocular pressure after phacoemulsification and intraocular lens implantation in nonglaucomatous eyes with and without exfoliation. J. Cataract Refract. Surg. 2001, 27 (3) : 426 -431. 11. Kung C. , Packer M. , Fine H. et al. Intraocular pressure during phacoemulsification. J. Cataract Refract. Surg. 2006; 32: 115 -9. Anmad Z. J. , Kashif I. , Fawad U. R. , Khuram A. M. Effect of phacoemulsification on intraocular pressure. Journal of the College of Physitians and Surgeons Pakistan. -2011. -Vol. 21. -P. 347 -350. Luce D. A. Determining in vivo biomechanical properties of the cornea with an ocular response analyzer. J. Cataract. Refract. Surg. – 2005. – Vol. 31. – P. 156 -162. Ryabtseva A. A. , Yugay M. P. Changes of biomechanical properties of the cornea after cataract phacoemulsification. Almanac of Clinical Medicine. 2015. -Vol. 36. - P. 13 -16.