{"id":2936,"date":"2015-09-09T18:44:56","date_gmt":"2015-09-09T18:44:56","guid":{"rendered":"https:\/\/sbglaucoma2.websiteseguro.com\/medico\/?p=2936"},"modified":"2019-06-21T17:04:10","modified_gmt":"2019-06-21T20:04:10","slug":"tratamento-cirurgico","status":"publish","type":"post","link":"https:\/\/www.sbglaucoma.org.br\/medico\/tratamento-cirurgico\/","title":{"rendered":"ACADEMIA AMERICANA DE OFTALMOLOGIA: EFEITO DA FACO na PIO DE PACIENTES COM GLAUCOMA"},"content":{"rendered":"
\n
\"Tiago-Prata\"Editor Associado e Comentarios por Tiago Prata sobre:
\nRef.: The Effect of Phacoemulsification on Intraocular Pressure in Glaucoma Patients. A Report by the American Academy of Ophthalmology<\/strong>
\nPhilip P. Chen, Shan C. Lin, Anna K. Junk, Sunita Radhakrishnan, Kuldev Singh, Teresa C. Chen
\nOphthalmology 2015 Jul;122(7):1294-307.<\/strong><\/div>\n<\/div>\n

 <\/p>\n

Os pacientes com glaucoma frequentemente encontram-se na faixa et\u00e1ria em que h\u00e1 coexist\u00eancia de catarata. Com isto em mente, a decis\u00e3o sobre a realiza\u00e7\u00e3o de cirurgia de catarata neste grupo deve levar em considera\u00e7\u00e3o a necessidade de se manter ou melhorar o controle da press\u00e3o intra-ocular (PIO) e buscar a estabilidade do dano glaucomatoso nestes pacientes.<\/p>\n

Este estudo tem o objetivo de avaliar complica\u00e7\u00f5es e o efeito da cirurgia de facoemulsifica\u00e7\u00e3o isolada no controle da PIO a longo prazo em pacientes com Glaucoma Prim\u00e1rio de \u00c2ngulo Aberto(GPAA), Glaucoma Prim\u00e1rio de \u00c2ngulo Fechado (GPAF) e Glaucoma Pseudoexfoliativo (PEX) tratados clinicamente. Para isto, foi conduzida uma revis\u00e3o de literatura na base de dados do Pubmed e Cochrane, sendo avaliados 32 estudos que preencheram os crit\u00e9rios de inclus\u00e3o estabelecidos.<\/p>\n

Observando-se a redu\u00e7\u00e3o da PIO e do n\u00famero de medica\u00e7\u00f5es para glaucoma ap\u00f3s a facoemulsifica\u00e7\u00e3o:
\n9 estudos de GPAA demostraram redu\u00e7\u00e3o de 13% e 12%,
\n5 estudos com PEX, redu\u00e7\u00e3o de 20% e 35%,
\n12 estudos com GPAF cr\u00f4nico, redu\u00e7\u00e3o de 30% e 58%<\/p>\n

Embora os dados sejam favor\u00e1veis com rela\u00e7\u00e3o \u00e0 realiza\u00e7\u00e3o da facoemulsifica\u00e7\u00e3o isoladamente, devemos interpretar os resultados com cautela e destacar limita\u00e7\u00f5es antes da generaliza\u00e7\u00e3o destes achados.<\/p>\n

Considerando-se essas ressalvas, os dados permitem sugerir que seja relativamente seguro a facoemulsifica\u00e7\u00e3o isolada em pacientes com GPAA e PEX controlados com 1 ou 2 medica\u00e7\u00f5es. Entretanto, sugerir que a cirurgia seja segura n\u00e3o quer dizer que a facoemulsifica\u00e7\u00e3o deva ser utilizada com o intuito de controle do glaucoma.<\/span><\/p>\n

Com rela\u00e7\u00e3o \u00e0s limita\u00e7\u00f5es, primeiramente, os dados prov\u00eam de estudos com n\u00edvel de evid\u00eancia baixo, sendo apenas 1 dos estudos um ensaio cl\u00ednico e a maior parte dos dados baseada em estudos n\u00edvel II (47%) e III (50%) de evid\u00eancia em sua maioria retrospectivos. Al\u00e9m disso, 56% dos estudos avaliaram apenas uma medida de PIO antes da cirurgia, de modo que a redu\u00e7\u00e3o de PIO observada ap\u00f3s a facoemulsifica\u00e7\u00e3o poderia ser influenciada por regress\u00e3o \u00e0 m\u00e9dia. Por fim, deve-se destacar tamb\u00e9m que a maior parte dos estudos excluiu pacientes com glaucoma avan\u00e7ado ou consideraram o glaucoma controlado apenas pela PIO, n\u00e3o apresentando dados com rela\u00e7\u00e3o \u00e0 severidade do glaucoma com rela\u00e7\u00e3o ao dano no campo visual e disco \u00f3ptico.<\/p>\n

Considerando-se essas ressalvas, os dados permitem sugerir que seja relativamente seguro a facoemulsifica\u00e7\u00e3o isolada em pacientes com GPAA e PEX controlados com 1 ou 2 medica\u00e7\u00f5es. Entretanto, sugerir que a cirurgia seja segura n\u00e3o quer dizer que a facoemulsifica\u00e7\u00e3o deva ser utilizada com o intuito de controle do glaucoma.<\/p>\n

Deve-se ressaltar que a mudan\u00e7a na PIO n\u00e3o foi clinicamente significativa na maioria dos estudos, variando entre 1 e 2,5mmHg na maioria deles e, al\u00e9m disso, houve perda do controle press\u00f3rico de at\u00e9 38% de pacientes previamente controlados, com necessidade de intensifica\u00e7\u00e3o do tratamento do glaucoma.<\/p>\n

avaliou GPAA n\u00e3o controlado, apesar de tamb\u00e9m ter sido observada uma redu\u00e7\u00e3o m\u00e9dia da PIO de 2,2mmHg, 84% dos pacientes continuaram n\u00e3o controlados e necessitaram de posterior cirurgia antiglaucomatosa. Outro dado importante \u00e9 que o risco m\u00e9dio de pico press\u00f3rico p\u00f3s operat\u00f3rio foi 17,5% no GPAA e ainda maior no PEX (21%), o que torna a cirurgia isolada uma estrat\u00e9gia menos indicada em casos de glaucoma avan\u00e7ado em o que pico press\u00f3rico p\u00f3s operat\u00f3rio seja considerado perigoso.<\/p>\n

Nos pacientes com GPAF controlados, os dados sugerem maior seguran\u00e7a da cirurgia, pois os riscos de necessidade de intensifica\u00e7\u00e3o do tratamento do glaucoma (4-9%) e de pico press\u00f3rico p\u00f3s operat\u00f3rio (8%) foram mais baixos. Nos pacientes com GPAF agudo foi observado 71% de redu\u00e7\u00e3o na PIO apresentada no momento do quadro agudo e rara necessidade de medica\u00e7\u00e3o quando a cirurgia era realizada rapidamente. Esses dados sugerindo melhor resposta no GPAF s\u00e3o suportados por estudos que observam associa\u00e7\u00e3o entre maior redu\u00e7\u00e3o da PIO e par\u00e2metros relacionados \u00e0 c\u00e2mara anterior, como maior aumento da sua profundidade.<\/p>\n

Deve-se ressaltar que a mudan\u00e7a na PIO n\u00e3o foi clinicamente significativa na maioria dos estudos, variando entre 1 e 2,5mmHg na maioria deles e, al\u00e9m disso, houve perda do controle press\u00f3rico de at\u00e9 38% de pacientes previamente controlados, com necessidade de intensifica\u00e7\u00e3o do tratamento do glaucoma.<\/span><\/p>\n

Deste modo, pode-se concluir dos dados do estudo que, embora a cirurgia de facoemulsifica\u00e7\u00e3o possa ser considerada segura nos pacientes com glaucoma controlado, principalmente nos portadores de GPAF, cuidados s\u00e3o necess\u00e1rio com rela\u00e7\u00e3o \u00e0 perda do controle do glaucoma nestes pacientes e ao pico press\u00f3rico p\u00f3s operat\u00f3rio. Importante ressaltar que casos de GPAF tendem a apresentar um grau de dificuldade t\u00e9cnica maior que olhos com c\u00e2mara anterior ampla, e cuidados especiais devem ser adequados para minimizar risco de complica\u00e7\u00f5es. Ainda n\u00e3o h\u00e1 dados suficientes com rela\u00e7\u00e3o \u00e0 sua seguran\u00e7a nos pacientes n\u00e3o controlados e casos de glaucoma avan\u00e7ado. Sendo assim, s\u00e3o necess\u00e1rios mais estudos prospectivos bem desenhados para fornecer melhores dados com rela\u00e7\u00e3o ao manejo dos pacientes com glaucoma e catarata.<\/p>\n

\n
\n

\"\"Resumo deste artigo<\/h3>\n
\n
\n
\n

Ophthalmology. 2015 Jul;122(7):1294-307. doi: 10.1016\/j.ophtha.2015.03.021. Epub 2015 May 2.
\nThe Effect of Phacoemulsification on Intraocular Pressure in Glaucoma Patients: A Report by the American Academy of Ophthalmology.<\/strong>
\nChen PP1, Lin SC2, Junk AK3, Radhakrishnan S4, Singh K5, Chen TC6.
\nAuthor information<\/p>\n

Abstract<\/strong><\/p>\n

OBJECTIVE:<\/strong>
\nTo examine effects of phacoemulsification on longer-term intraocular pressure (IOP) in patients with medically treated primary open-angle glaucoma (POAG; including normal-tension glaucoma), pseudoexfoliation glaucoma (PXG), or primary angle-closure glaucoma (PACG), without prior or concurrent incisional glaucoma surgery.<\/p>\n

METHODS:<\/strong>
\nPubMed and Cochrane database searches, last conducted in December 2014, yielded 541 unique citations. Panel members reviewed titles and abstracts and selected 86 for further review. The panel reviewed these articles and identified 32 studies meeting the inclusion criteria, for which the panel methodologist, assigned a level of evidence based on standardized grading adopted by the American Academy of Ophthalmology. One, 15, and 16 studies were rated as providing level I, II, and III evidence, respectively.<\/p>\n

RESULTS:<\/strong>
\nAll follow-up, IOP, and medication data listed are weighted means. In general, the studies reported on patients using few glaucoma medications (1.5-1.9 before surgery among the different diagnoses). For POAG, 9 studies (total, 461 patients; follow-up, 17 months) showed that phacoemulsification reduced IOP by 13% and glaucoma medications by 12%. For PXG, 5 studies (total, 132 patients; follow-up, 34 months) showed phacoemulsification reduced IOP by 20% and glaucoma medications by 35%. For chronic PACG, 12 studies (total, 495 patients; follow-up, 16 months) showed phacoemulsification reduced IOP by 30% and glaucoma medications by 58%. Patients with acute PACG (4 studies; total, 119 patients; follow-up, 24 months) had a 71% reduction from presenting IOP and rarely required long-term glaucoma medications when phacoemulsification was performed soon after medical reduction of IOP. Trabeculectomy after phacoemulsification was uncommon; the median rate reported within 6 to 24 months of follow-up in patients with controlled POAG, PXG, or PACG was 0% and was 7% in patients with uncontrolled chronic PACG.<\/p>\n

CONCLUSIONS:<\/strong><\/p>\n

Phacoemulsification typically results in small, moderate, and marked reductions of IOP and medications for patients with POAG, PXG, and PACG, respectively, and using 1 to 2 medications before surgery. Trabeculectomy within 6 to 24 months after phacoemulsification is rare in such patients. However, reports on its effects in eyes with advanced disease or poor IOP control before surgery are few, particularly for POAG and PXG.
\nCopyright \u00a9 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Editor Associado e Comentarios por Tiago Prata sobre: Ref.: The Effect of Phacoemulsification on Intraocular Pressure in Glaucoma Patients. A Report by the American Academy of Ophthalmology Philip P. Chen, Shan C. Lin, Anna K. Junk, Sunita Radhakrishnan, Kuldev Singh, Teresa C. Chen Ophthalmology 2015 Jul;122(7):1294-307.   Os pacientes com glaucoma frequentemente encontram-se na faixa […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_joinchat":[],"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2936","post","type-post","status-publish","format-standard","hentry","category-sem-categoria"],"acf":[],"yoast_head":"\nACADEMIA AMERICANA DE OFTALMOLOGIA: EFEITO DA FACO na PIO DE PACIENTES COM GLAUCOMA - SBG - Sociedade Brasileira de Glaucoma<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.sbglaucoma.org.br\/medico\/tratamento-cirurgico\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ACADEMIA AMERICANA DE OFTALMOLOGIA: EFEITO DA FACO na PIO DE PACIENTES COM GLAUCOMA - SBG - Sociedade Brasileira de Glaucoma\" \/>\n<meta property=\"og:description\" content=\"Editor Associado e Comentarios por Tiago Prata sobre: Ref.: The Effect of Phacoemulsification on Intraocular Pressure in Glaucoma Patients. 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