Comparing Phacoemulsification and Extracapsular Cataract Extraction in Eyes with Pseudoexfoliation Syndrome, Small Pupil, and Phacodonesis

Zusammenfassung

Hintergrund: Diese Studie hatte zum Ziel, die Häufigkeit der intra- und postoperativen Komplikationen zwischen der modernen Phakoemulsifikationstechnik und der extrakapsulären Kataraktextraktion bei Patienten mit Pseudoexfoliationssyndrom zu vergleichen. Patienten und Methoden: Diese prospektive randomisierte Studie schloss 94 Augen mit Katarakt, Pseudoexfoliationssyndrom, engen Pupillen und leichter bis mäßiger Phakodonesis ein. Diese Augen wurden in zwei Gruppen randomisiert. Alle Patienten der ersten Gruppe (47 Augen) wurden mittels standardisierter Phakoemulsifikationstechnik operiert: Irishaken, Anfärben der vorderen Kapsel, Kapsulorhexis und Implantation eines Kapselspannrings. Alle Patienten der zweiten Gruppe (47 Augen) wurden vom selben Chirurgen mittels einer klassischen extrakapsulären Kataraktoperation operiert. Hauptendpunkte dieser Studie waren die Häufigkeit eines intraoperativen Zonulafasernabrisses, einer Kapselruptur, eines Glaskörperverlusts und eines Korneaödems. Des Weiteren wurde der bestkorrigierte Visus bestimmt. Ergebnisse: Bei einem Auge (2,1 %) der ersten Gruppe und in 15 Augen (31,9 %) der zweiten Gruppe trat intraoperativ eine Dehiszenz der Zonulafasern auf (p < 0,001). Eine Ruptur der hinteren Kapsel mit oder ohne Dehiszenz der Zonulafasern trat in 2 Augen (4,2 %) der ersten Gruppe und in 8 Augen (17,0 %) der zweiten Gruppe (p < 0,05) auf. Auch ein Glaskörperverlust trat in der zweiten Gruppe häufiger auf als in der ersten Gruppe: 17 versus 4,2 %, p < 0,05. Der Unterschied des bestkorrigierten Visus fiel ebenfalls statistisch signifikant aus: In der ersten Gruppe war er besser (p < 0,001). Schlussfolgerungen: In den schwierigen Fällen einer Katarakt, vergesellschaftet mit Pseudoexfoliationssyndrom, engen Pupillen und Phakodonesis, bietet die moderne Operationstechnik mit kleiner Inzision im Vergleich zur extrakapsulären Kataraktextraktion bessere Resultate mit einer geringeren intra- und postoperativen Komplikationsrate.

Abstract

Background: This study aims to compare the frequency of intraoperative and postoperative complications between the modern phacoemulsification technique and the extracapsular cataract extraction technique in patients with pseudoexfoliation syndrome. Patients and methods: A prospective randomized study comprised 94 eyes with cataract, pseudoexfoliation syndrome, small pupil and slight to moderate phacodonesis. These eyes were randomly assigned into two groups. In the first group all patients (47 eyes) were operated on using a standard phacoemulsification technique (iris hooks, anterior capsule staining and capsular tension ring after capsulorhexis), while in the second group all patients (47 eyes) underwent a classic extracapsular cataract extraction. The main outcome measures were the frequency of intraoperative zonular tears, capsular rupture, vitreous loss and corneal edema, as well as the best-corrected visual acuity. Results: Intraoperative zonular separation was recorded in one eye (2.1 %) and in 15 eyes (31.9 %) for the first and second groups, respectively (P < 0.001). Posterior capsule rupture with or without zonular separation occurred in two eyes (4.2 %) of the first group and in eight eyes (17.0 %) of the second group (P < 0.05). Vitreous loss also had a higher rate in the second group (17.0 % versus 4.2 %, P < 0.05). The postoperative difference in best-corrected visual acuity was also significant between the two groups, being higher in patients operated on using phacoemulsification technique (P < 0.001). Conclusions: In the difficult cases of cataract associated with pseudoexfoliation syndrome, small pupil and phacodonesis, the modern small-incision cataract surgery provides better results with a low rate of intraoperative and postoperative complications when compared with the extracapsular cataract extraction technique.

Phakoemulsifikation - extrakapsuläre Kataraktextraktion - Pseudoexfoliationssyndrom - enge Pupille - Phakodonesis - Komplikationen

Phacoemulsification - extracapsular cataract extraction - pseudoexfoliation syndrome - small pupil - phacodonesis - complications

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