Ординатура / Офтальмология / Английские материалы / Shields Textbook of Glaucoma, 6th edition_Allingham, Damji, Freedman_2010
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margins of the equatorial bleb (yellowarrows) and the tube covered by a patch graft that prevents erosion (black arrows). D: Gonioscopic view of trabeculotomy cleft (white arrow) in a patient who has undergone Trabectome surgery combined with cataract extraction. E: Endoscopic cyclophotocoagulation performed in conjunction with phacoemulsification. The white area represents coagulation and shrinkage of the ciliary body processes, and the red circle is the aiming beam on the adjacent process. F: Gonioscopic view of patient after canaloplasty and phacoemulsification. Note the blue 10-0 Prolene sutures in the Schlemm canal. G: Deep sclerectomy and viscocanalostomy are similar forms of nonpenetrating surgery that may also be combined with lens extraction. (From Fellman RL, Starita RJ, Godfrey DG, et al. Cataract extraction in patients with glaucoma. In: Tasman W, Jaeger EA, eds. Duane's Clinical Ophthalmology Vol 6. Philadelphia:Lippincott Williams & Wilkins; 2008:chap 16.) P.585
KEY POINTS
In an eye with a cataract, for which extraction is believed to be indicated, and coexisting glaucoma, the surgical approach is based primarily on the status of the glaucoma.
In some eyes, cataract extraction alone may be sufficient, whereas other eyes may require filtering surgery alone with cataract surgery at a later date. In other eyes, a combined glaucoma and cataract operation may be the procedure of choice.
The preferred technique for the glaucoma portion of a combined procedure is usually some form of guarded filtering surgery. The combination of phacoemulsification with a guarded filtering procedure, possibly in conjunction with antimetabolite therapy, appears to have improved the long-term success rate of the combined procedure.
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