Razi Journal of Medical Sciences

fa مقایسه فراوانی فیموز کپسول قدامی لنز، تغیرات دید و فشار داخل چشمی بعد از جراحی کاتاراکت در بیماران مبتلا به سندروم سودواکسفولیاسیون با و بدون استفاده از قطره ضد التهاب غیر استروییدی Comparison of the Frequency of Lens Capsule Opacification And Phimosis, Vision Changes, and Intraocular Pressure after Cataract Surgery in Patients with Pseudoexfoliation Syndrome with and Without the Use of Nonsteroidal Anti-Inflammatory Drops چشم Ophthalmology پژوهشي Research <div style="text-align: justify;"> زمینه و هدف: افراد با سندرم سودواکسفولیاسیون بعد از عمل کاتاراکت، التهاب بعد از عمل بیشتری نسبت به افراد نرمال دارند که منجر به عوارض متعددی در سگمان قدامی و خلفی میشود. در مطالعه حاضر مقایسه فراوانی کدورت و فیموز کپسول قدامی  Phimosis، تغیرات دید و فشار داخل چشمی IOP بعد از جراحی کاتاراکت در افراد مبتلا به سندروم سودواکسفولیاسیون بررسی شد. روش کار: در این مطالعه، 88 بیمار با کاتاراکت همراه با سندرم سودواکسفولیاسیون که کاندید عمل جراحی فیکو بودند به صورت راندوم در 2 گروه قرار گرفتند. از روز اول بعد از  عمل، در گروه اول قطرههای 5/0% Chloramphenicol و 1/0%Betamethasone و در گروه دوم علاوه بر این قطرهها، از قطره 5/0% ketorolac tromethamine هم به مدت دو هفته استفاده شد. در دو گروه میزان التهاب اتاقک قدامی, فشار داخل چشم(IOP) ، دید اصلاح شده در روزهای 1 و 3 و 7 و 30 بعد از عمل و درجه کدورت کپسول قدامی و فیموزیس کپسول قدامی در ماه ششم پیگیری، ثبت گردید. یافته ها: در این مطالعه میانگین دید بیماران در هر دو گروه نسبت به قبل از عمل جراحی در تمامی زمانهای پیگیری بهبود پیدا کرد و در مقایسه بین دو گروه مورد مطالعه تفاوت معنی‌دار آماری وجود نداشت. میانگین فشار داخل چشمی بیماران در اولین پیگیری بعد از عمل جراحی نسبت به قبل از عمل جراحی تفاوت عددی و آماری معنی‌داری نداشت. میزان کدورت کپسول قدامی و فیموز کپسول قدامی در گروه دریافت کننده قطره کتورو لاک بطور واضحی کمتر از گروه دیگر مطالعه بود به‌طوری‌که این کاهش از نظر آماری معنیدار است. نتیجه‌گیری: با توجه به نتایج مطالعه حاضر در بیماران سودواکسفولیاسیون استفاده از قطره ضد التهاب غیر استروییدی میتواند به بهتر شدن دید و فشار داخل چشمی بعد از جراحی و همچنین کاهش عوارض کدورت کپسولی و کپسولار فیموزیس کمک کند. </div> <div style="text-align: justify;">Background & Aims: Pseudoexfoliation syndrome is a systemic disease in which extracellular matrix of fibrillar material is deposited in many organs. In the eye, this white fibrinogranular material resembling basement membrane is formed on the lens, cornea, iris, anterior hyaloid, ciliary processes, zenular fibers and trabecular meshwork. These deposits, which consist of elastic microfibrils, appear as grayish-white flecks that are characterized by the pupil margin and lens capsule. Associated features of this syndrome include: iris atrophy at the pupil margin, pigment deposition on the anterior surface of the iris, a pupil that is difficult to dilate, increased pigmentation of the trabecular meshwork, capsular fragility, zenular weakness, and open-angle glaucoma. Pseudoexfoliation syndrome is a unilateral or bilateral disease that is characterized by increased age. Increased oxidative stress due to increased TGF-β levels is implicated in the development of cataracts in these cases. Patients with this syndrome may have zenular fiber weakness and spontaneous lens displacement and phycodonosis. Zenular weakness may affect cataract surgical technique and IOL placement. Exfoliative material may be produced even after removal of the crystalline lens. Nonsteroidal anti-inflammatory drugs have been investigated for the treatment of inflammation and pain after cataract surgery. Although topical NSAIDs control inflammation after cataract surgery, there is little information on whether NSAIDs combined with topical steroids can further reduce inflammation after cataract surgery. In the present study, the frequency of anterior capsule opacification and phimosis, visual changes, and IOP after cataract surgery in patients with pseudoexfoliation syndrome were compared. Methods: In this Randomized Clinical Trial, 88 patients with cataract with pseudoexfoliation syndrome who were candidates for phacoemulsification surgery were randomly assigned to 2 groups. From the first day after surgery, 0.5% chloramphenicol and 0.1% betamethasone drops were used in the first group, and in the second group, 0.5% ketorolac tromethamine drops were used in addition to these drops for two weeks. In the two groups, the degree of anterior chamber inflammation, intraocular pressure (IOP), Best Corrected Visual Acuity (BCVA) on days 1, 3, 7, and 30 after surgery, and the degree of anterior capsule opacification and anterior capsule phimosis at the sixth month of follow-up were recorded. Inclusion criteria included significant cataract (grade 3 and above) with PEX on slit lamp examination, no history of taking any oral, inhaled, or topical NSAID one week before surgery, and no history of taking any systemic, inhaled, or topical corticosteroids within 15 days before surgery. Exclusion criteria included sensitivity to NSAID compounds, history of uncontrolled chronic and systemic ocular disease, history of ocular inflammation or trauma, intraoperative complications such as posterior capsule rupture and vitreous loss, extracapsular or intracapsular cataract surgery, and need for systemic anti-inflammatory drugs due to severe postoperative inflammation. Results: In this study, the average vision of patients in both groups improved compared to before surgery at all follow-up times, and there was no statistically significant difference between the two study groups (p>0.05). The average intraocular pressure of patients in the first follow-up after surgery did not have a numerical or statistical difference compared to before surgery, and there was no significant difference between the two groups (p>0.05). The rate of anterior capsule opacity and anterior capsule phimosis in the group receiving Ketorolac drops was clearly lower than in the other study group, so that this reduction is statistically significant. Conclusion: According to the results of the present study, the use of nonsteroidal anti-inflammatory (NSAID) drops in pseudoexfoliation patients can help improve vision and intraocular pressure after surgery, as well as reduce the complications of capsular opacities and capsular phimosis. The mean intraocular pressure of the patients in the first follow-up after surgery did not have a significant numerical or statistical difference compared to before surgery, and no significant difference was observed in the comparison between the two groups (p>0.05). In the comparison of the mean IOP reduction between the two groups, the statistical difference in the first and sixth months was close to being significant, P value for the first month (p=0.022) and sixth month (p=0.055), respectively; but in other follow-ups, no significant difference was observed between the two groups. In the present study, the postoperative inflammation rate in the ketorolac group was clearly lower than in the other study group, so that this reduction, which is statistically significant, starts from the third day after surgery based on the degree of cell and flare in the anterior chamber and continues until the one-month follow-up. PEX patients are prone to more inflammation, especially in the first days after phacoemulsification surgery, due to the deposition of fibrillar materials inside the eye. In a prospective study by Sufi et al. in Kashmir, it was observed that PEX-positive patients had higher degrees of inflammation and increased intraocular pressure after phacoemulsification surgery (p<0.05).</div> جراحی کاتاراکت, سندرم سودواکسفولیاسیون, فراوانی فیموز کپسول, تغییرات دید Cataract Surgery, Pseudoexfoliation Syndrome, Frequency of Capsular Phimosis, Vision Changes 1 11 http://rjms.iums.ac.ir/browse.php?a_code=A-10-8494-2&slc_lang=fa&sid=1 Mitra Akbari میترا اکبری mitra.akbari20@gmail.com 3900319475328460087400 3900319475328460087400 Yes M.D. Associate Professor of Ophthalmology, Cornea and Anterior Segment Fellowship, Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Science, Rasht, Iran دانشیار چشم‌پزشکی، فلوشیپ قرنیه و سگمان قدامی، مرکز تحقیقات چشم، بخش چشم، بیمارستان امیرالمؤمنین، دانشکده پزشکی، دانشگاه علوم پزشکی گیلان، رشت، ایران Reza Soltani Moghadam رضا سلطانی مقدم 3900319475328460087401 3900319475328460087401 No M.D. Professor of Ophthalmology, Cornea and Anterior Segment Fellowship, Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Science, Rasht, Iran استاد چشم‌پزشکی، فلوشیپ قرنیه و سگمان قدامی، مرکز تحقیقات چشم، بخش چشم، بیمارستان امیرالمؤمنین، دانشکده پزشکی، دانشگاه علوم پزشکی گیلان، رشت، ایران Anvar Mohamadpour انور محمدپور 3900319475328460087402 3900319475328460087402 No M.D. Ophthalmologist, Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Science, Rasht, Iran چشم‌پزشک، مرکز تحقیقات چشم، بخش چشم، بیمارستان امیرالمؤمنین، دانشکده پزشکی، دانشگاه علوم پزشکی گیلان، رشت، ایران Ehsan Kazemnezhad Leili احسان کاظم‌نژاد لیلی 3900319475328460087403 3900319475328460087403 No PhD. Associate Professor of Biostatistics, Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Science, Rasht, Iran دانشیار آمار زیستی، مرکز تحقیقات چشم، بخش چشم، بیمارستان امیرالمؤمنین، دانشکده پزشکی، دانشگاه علوم پزشکی گیلان، رشت، ایران Ebrahim Azaripour ابراهیم آذری‌پور 3900319475328460087404 3900319475328460087404 No M.D. Assistant Professor of Ophthalmology, Glaucoma Fellowship, Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Science, Rasht, Iran دانشیار چشم‌پزشکی، فلوشیپ گلوکوم، مرکز تحقیقات چشم، بخش چشم، بیمارستان امیرالمؤمنین، دانشکده پزشکی، دانشگاه علوم پزشکی گیلان، رشت، ایران Mohammad Rasoul Sabouri محمد رسول صبوری 3900319475328460087405 0009-0004-7525-6411 No M.D. Associate Professor of Ophthalmology, Vitreo-retinal Fellowship, Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Science, Rasht, Iran دانشیار چشم‌پزشکی، فلوشیپ ویتره و رتین، مرکز تحقیقات چشم، بخش چشم، بیمارستان امیرالمؤمنین، دانشکده پزشکی، دانشگاه علوم پزشکی گیلان، رشت، ایران