Influence of local abnormalities and systemic disorders to phacotrabeculectomy and post-operative period

Introduction
The aim is to present that local abnormalities of eyes chronically treated for glaucoma and cardiovascular, metabolic disorders may influence the course of phacotrabeculectomy and post-­operative period.

Material and methods
The research covered 68 patients. In 89 eyes phacoemulsification of cataract connected with Cairns-type trabeculectomy and implantation of lens prosthesis has been performed. The patients were divided into two groups: I group – 37 patients, 45 surgeries. All patients were chronically treated for arterial hypertension and other cardiovascular disorders. 7 patients had non-insulin-­dependent type II diabetes mellitus without diabetic retinopathy. II group – 31 patients without cardiovascular and metabolic disorders, 44 surgeries. Stromal atrophy and posterior synechiae were recognized as local abnormalities (12 eyes in I group and 18 eyes in II group). They were released during phacotrabeculectomy.

Results
In post-­operative period, higher coefficients of complications such as hematoceles or blood in the anterior chamber were shown in both groups, more incidents of fibrinous reaction in I group and exudate in the anterior chamber after release of posterior synechiae in II group. Statistically significant difference at p=0,016 was observed only in comparison of the incidence of complications after release of choroid-lens synechiae in I group, in comparison to II group, where synechiae were not released. Choroidal detachment was observed in 8 eyes of I group and in 1 eye of II group. Anterior chamber reconstructed in 3 eyes of I group and 1 of II group was noted. In one case of booth groups, drainage of the suprachoroid space were performed. The study didn’t show statistically significant differences in the frequency of fibrinous reaction or inflammatory exudates in 9 eyes of diabetic patients, in comparison to other patients of I group.

Conclusions
Additional procedures, especially releasing of posterior synechiae are corelated with most often early complications as hematoceles, hyphema in anterior chamber, exudate or fibrinous reaction. Cardiovascular disorders are associated with non stability of choroidal circulation, that with post-­operative hypotony may correlated with choroidal detachment. In patient with non-insulin-­dependent type II diabetes mellitus without diabetic retinopathy, fibrinous reaction or inflammatory exudate, clinical symptoms of blood-­aqueous humor barrier damage were not observed in every case.