Oce­na sku­tecz­no­ści ope­ra­cji wie­lo­pro­ce­du­ral­nych w le­cze­niu współ­ist­nie­ją­cych za­ćmy i ja­skry

Introduction
There are currently some techniques of combined cataract and glaucoma treatment. They have been under debate for many years. We present efficacy of different techniques of combined cataract and glaucoma surgery.

Material and methods
50 patients (60 eyes, 21 male and 29 female), mean age 64.9± 5.6 years enrolled in the study were divided into 3 groups in which the combined surgery were performed. Group 1: phacotrabeculectomy (20 patients, 27 eyes) (FT), group 2: phacoemulsification combined with deep nonperforative sclerectomy (20 patients, 23 eyes) (FS) and group 3: phacoemulsification combined with iridocleisis (10 patients, 10 eyes) (FW). Measure outcomes during 6 months of follow up were: value of postoperative intraocular pressure, visual acuity, pre and postoperative antyglaucoma medications ratio, intra and postoperative complications.

Results
There were not differences in preoperative intraocular pressure (IOP) among group 1 and 2 Significantly higher IOP was assessed in group 3. Preoperative antyglaucoma medications ratio was the highest in group 3 (3.5 ± 1.5) as compared with group 1 and 2, (2.0 ± 1.5). Postoperatively mean value of IOP was significantly lower as compared with the value in preoperative period in each group. After 3 months of follow up the IOP lower than 20mmHg was achieved in 81.5% eyes in group 1, 73.9% eyes in group 2 and in 40 % of eyes in group 3. Six months postoperatively the target IOP was decreased to 62.9% in group 1 and 65.2% in group 2 and slightly increased to 50% in group 3. Postoperative antiglaucoma medications ratio was higher in group 3 (2.0 ± 1.0), as compared with group 1 and 2, (1.5 ± 1.0). The best visual acuity after 6 month of follow up was achieved in group 2, (0.8 ± 0.2). More severe intraoperative complications such as: anterior chamber bleeding as well as postoperative complications eg.: hypotension, inflammation were noticed particularly in group 1 and 3 and choroidal effusion only in group 1.

Conclusions
Efficacy in lowering of IOP after FT and FS is the highest within first 3 months postoperatively. In the late postoperative period the efficacy of these methods is significantly decreasing and additional conservative treatment has to be introduced. Interestingly, the efficacy of IOP normalization after FW in the late postoperative period increases. Most of intra and postoperative complications are link up on FT and FW techniques. Our results suggest that further investigations and preparing more adequate indications for surgical strategy among patients with combined cataract and glaucoma are needed.