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Inicio Archivos de la Sociedad Española de Oftalmología (English Edition) Combined phacoemulsification and XEN45 surgery from a temporal approach and 2 in...
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Vol. 91. Issue 9.
Pages 415-421 (September 2016)
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Vol. 91. Issue 9.
Pages 415-421 (September 2016)
Original article
Combined phacoemulsification and XEN45 surgery from a temporal approach and 2 incisions
Cirugía combinada mediante facoemulsificación e implante XEN45 con acceso temporal y 2 únicas incisiones
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V.T. Pérez-Torregrosa
Corresponding author
, Á. Olate-Pérez, M. Cerdà-Ibáñez, A. Gargallo-Benedicto, V. Osorio-Alayo, A. Barreiro-Rego, A. Duch-Samper
Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, Spain
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Table 1. Surgical difficulties and complications of FACO-XEN surgery.
Abstract
Objective

To assess the safety and effectiveness of phacoemulsification combined with XEN45 implant surgery in patients with cataract and open-angle glaucoma, with 12-month follow-up.

Methods

A prospective study conducted on 30 eyes requiring phacoemulsification with, at least, 2 medications to control intraocular pressure (IOP). Phacoemulsification combined with XEN45 implant surgery was performed within 15min of administering subconjunctival mitomycin C. Surgery was performed through 2 temporal incisions, separated by 90°, using the inferior to enter the XEN45 and to implant it in the superior nasal region. A record was made of the best corrected visual acuity, IOP before and 1 day, 1 month, 3 months, 6 months, 9 months, and 12 months after surgery, the number of antiglaucomatous medications, and complications.

Results

The best corrected visual acuity was 0.37±0.2 and 0.72±0.15 before and 12 months after surgery, respectively. The pre-operative IOP was 21.2±3.4mmHg, with 3.07 drugs, decreasing by 61.65% on the first day, 37.26% at 1 month, 35.05% at 3 months, 31% at 6 months, 30.6% at 9 months, and 29.34% at 12 months. The number of medications decreased by 94.57%. Complications occurred in 3 eyes, 2 of them were excluded because we could not complete the implantation (280° subconjunctival hemorrhage and XEN extrusion when trying to reposition). In a third case, the bleb was encapsulated at 5 months after surgery.

Conclusions

The phacoemulsification combined with XEN45 implant surgery can effectively reduce IOP and the number of drugs in mild-moderate open-angle glaucoma, as they rehabilitate the VA. The use of only 2 micro-invasive incisions makes it simple, quick and safe, with few complications at 12 months follow-up from surgery.

Keywords:
Collagen
Glaucoma drainage implant
Open-angle glaucoma/surgery
Intraocular pressure
Stents
Microsurgery/methods
Resumen
Objetivo

Analizar la eficacia y seguridad de la técnica combinada de facoemulsificación e implante XEN45 empleando acceso temporal y 2 únicas incisiones, en casos de catarata y glaucoma crónico de ángulo abierto, con seguimiento de 12 meses.

Métodos

Estudio prospectivo de 30 ojos que requerían facoemulsificación y que precisaban, al menos, dos medicamentos para controlar presión intraocular (PIO). Se efectuó cirugía combinada de facoemulsificación e implante XEN45 a los 15min de administrar mitomicina C subconjuntival. El procedimiento se realizó a través de 2 incisiones temporales, separadas por 90°, utilizando la inferior para introducir el XEN45 e implantarlo en región nasal superior. Se registró agudeza visual mejor corregida, PIO previa y en días 1-30-90-180-270 y 365 poscirugía, número de medicamentos hipotensores y complicaciones.

Resultados

La agudeza visual mejor corregida preoperatoria fue 0,37±0,2 y 0,72±0,15 a los 12 meses. La PIO previa fue 21,2±3,4mmHg con 3,07 fármacos, descendiendo un 61,65% el primer día, 37,26% al mes, 35,05% al tercer mes, 31% al sexto mes, 30,6% al noveno mes y 29,34% a los 12 meses. El número de fármacos disminuyó un 94,57%. Solo hubo complicaciones destacables en 3 ojos, de ellos, 2 se excluyeron al no poder completar implantación (uno por hemorragia subconjuntival en 280° y otro, por extrusión del XEN al intentar recolocarlo). En un tercero, la ampolla se encapsuló a los 5 meses poscirugía.

Conclusiones

La cirugía combinada de facoemulsificación e implante XEN45 reduce eficazmente la PIO y el número de medicamentos en el glaucoma crónico de ángulo abierto leve-moderado, al tiempo que rehabilita la AV. El empleo de solo 2 incisiones posibilita una cirugía microinvasiva sencilla, rápida y segura con escasas complicaciones tras 12 meses de seguimiento.

Palabras clave:
Colágeno
Implante de drenaje glaucoma
Glaucoma de ángulo abierto/cirugía
Presión intraocular
Stents
Microcirugía

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