TY - JOUR A1 - Matlach, Juliane A1 - Freiberg, Florentina Joyce A1 - Leippi, Swetlana A1 - Grehn, Franz A1 - Klink, Thomas T1 - Comparison of phacotrabeculectomy versus phacocanaloplasty in the treatment of patients with concomitant cataract and glaucoma JF - BMC Ophthalmology N2 - Background Cataract and glaucoma are both common comorbidities among older patients. Combining glaucoma surgery with minimal invasive phacoemulsification (phaco) is a considerable option to treat both conditions at the same time, although the combination with filtration surgery can produce a strong inflammatory response. Combined non-penetrating procedures like canaloplasty have shown to reduce intraocular pressure (IOP) comparable to trabeculectomy without the risk of serious bleb-related complications. The purpose of this retrospective study was to compare the outcomes of phacotrabeculectomy and phacocanaloplasty. Methods Thirty-nine eyes with concomitant cataract and glaucoma who underwent phacotrabeculectomy (n = 20; 51.3%) or phacocanaloplasty (n = 19; 48.7%) were included into this trial on reduction of IOP, use of medication, success rate, incidence of complications and postsurgical interventions. Complete success was defined as IOP reduction by 30% or more and to 21 mmHg or less (definition 1a) or IOP to less than 18 mmHg (definition 2a) without glaucoma medication. Results Over a 12-month follow-up, baseline IOP significantly decreased from 30.0 ± 5.3 mmHg with a mean of 2.5 ± 1.2 glaucoma medications to 11.7 ± 3.5 mmHg with a mean of 0.2 ± 0.4 medications in eyes with phacotrabeculectomy (P < .0001). Eyes with phacocanaloplasty had a preoperative IOP of 28.3 ± 4.1 mmHg and were on 2.8 ± 1.1 IOP-lowering drugs. At 12 months, IOP significantly decreased to 12.6 ± 2.1 mmHg and less glaucoma medications were necessary (mean 1.0 ± 1.5 topical medications; P < .05). 15 patients (78.9%) with phacotrabeculectomy and 9 patients (60.0%) in the phacocanaloplasty group showed complete success according to definition 1 and 2 after 1 year (P = .276). Postsurgical complications were seen in 7 patients (36.8%) of the phacocanaloplasty group which included intraoperative macroperforation of the trabeculo-Descemet membrane (5.3%), hyphema (21.1%) and bleb formation (10.5%). Although more complications were observed in the phacotrabeculectomy group, no statistically significant difference was found. Conclusions Phacocanaloplasty offers a new alternative to phacotrabeculectomy for treatment of concomitant glaucoma and cataract, although phacotrabeculectomy yielded in better results in terms of IOP maintained without glaucoma medications. KW - Non-penetrating glaucoma surgery KW - Phacotrabeculectomy KW - Phacocanaloplasty KW - Canaloplasty KW - Trabeculectomy KW - Augenkrankheit Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-95948 UR - http://www.biomedcentral.com/1471-2415/13/1 ER - TY - THES A1 - Wahl, Iris T1 - Osteo-Odonto-Keratoprothese (OOKP) - Eine Erhebung der Kosten und der Auswirkungen auf die Lebensqualität T1 - Osteo-odonto-keratoprosthesis (OOKP) or Tibia-bone prosthesis (TK-Pro) - a costs and quality of life analysis N2 - Osteo-Odonto-Keratoprothese (OOKP) Eine Erhebung der Kosten und der Auswirkungen auf die Lebensqualität EINLEITUNG: Eine Keratoprothese mit natürlicher Haptik aus Zahn (OOKP) oder Knochen (Tibia-KPro) kann zur visuellen Rehabilitation hornhautblinder Patienten genutzt werden. In einer ersten Operation wird die Augenoberfläche mit Mundschleimhaut bedeckt, um ein geeignetes Milieu für das Implantat zu schaffen. Während desselben oder eines zweiten Eingriffs wird ein Zahn bzw. ein Stück Tibiaknochen gewonnen und als Haptik für eine PMMA-Optik präpariert. Das Gesamtimplantat wird für 3 Monate zwecks Bildung einer vaskularisierten Hülle in eine subkutane Tasche und in einem letzten Schritt in das Auge implantiert. In dieser Studie wurden die Kosten des Verfahrens und die resultierende Lebensqualität einer deutschen Kohorte mit mindestens 2-jähriger Beobachtungszeit ermittelt. MATERIAL UND METHODEN: Die Behandlungsdaten von 32 Patienten (27 x OOKP, 5 x TK-Pro) zu Personalbindung (z. B. Op-Dauer), Verbrauchsgüter und Infrastruktur wurden basierend auf der Kalkulationsmatrix des InEK ermittelt. Daraus wurden die mittleren Kosten für die regulären Operationsschritte, Vor- und Nachuntersuchungen über 2 Jahre postoperativ sowie kleine und große Eingriffe zum Komplikationsmanagement berechnet. Der prä- und postoperative Visus wurde aus den Akten und einer Selbsteinschätzung der Aktivitäten des täglichen Lebens und der Lebensqualität retrospektiv mittels Fragebogen vom Patienten erhobenen. ERGEBNIS: Die mittleren Kosten pro Patient betrugen für Schleimhautdeckung und Erstellung der Prothese 9.015 € und für die Implantation 7.896 €. Hinzu kamen Kosten für Vor- und Nachuntersuchungen über zwei Jahre beim Operateur von 336 € bzw. 1.947 € sowie für große und kleine Komplikationseingriffe von 5.177 € bzw. 1.579 €. Die Veränderung von Visus und Lebensqualität wurde von den Patienten als substantiell und als nahezu gleich wie vor der Augenerkrankung eingeschätzt. Der Visus lag vor der Operation bei einem Median von 0,001 und nach der Operation bei einem Median von 0,4. Das Lesen von normalem Text, Erkennen von Gesichtern und Orientieren im Raum war postoperativ 58%, 73% und 81% der Patienten wieder möglich. FAZIT: Die Implantation einer Keratoprothese mit natürlicher Haptik ist ein kostenintensives Verfahren, das jedoch in hohem Maße eine weitreichende visuelle Rehabilitation mit entsprechend subjektiv deutlich besser bewerteter Lebensqualität ermöglicht. N2 - Osteo-odonto-keratoprosthesis (OOKP) or Tibia-bone prosthesis (TK-Pro) - a costs and quality of life analysis Wahl I., Hille K., Wagner F., Geerling G. INTRODUCTION: OOKP is an extensive procedure for the treatment of severe corneal disease with resulting bilateral blindness. It consists of a number of complex surgical stages with highly trained ophthalmic and maxillofacial surgeons involved. In stage I the keratoprosthesis is prepared from the root of a canine tooth as a haptic and an optic cylinder. Three month later in stage II this prosthesis is implanted into the eye following excision of cornea, lens, iris and vitreous body. If successful this procedure can rehabilitate a patient from blindness to full visual acuity. We calculated the costs of this complex procedure and evaluated the effects on quality of life in a retrospective case series. MATERIAL AND METHODS: The medical records of 32 patients who received an OOKP (N=27) or TK-Pro (N=5) for corneal blindness in a tertiary referral centre were reviewed. The costs for personnel, consumables and infrastructure were calculated for visits to the out-patient clinic, ward (including diagnostic procedures such as x-rays) and surgical theatre of the primary OOKP surgical stages as well as treatment of complications. Vision based daily life activities and quality of life were retrospectively assessed with a questionnaire in 26 out of 32 patients after surgery. RESULTS: The total costs for treatment, including preoperative assessment, stage I and stage II and two years of follow-up were 19.194 €. 336 € for preoperative assessment, 9.015 € for stage I and 7.896 € for stage II. The costs of follow-up visits to the outpatient clinic were 1.947 €. Costs for additional hospital stays to treat complications amounted to 6.756 €. 1.579 € for small operations, such as mucosa membrane revision and 5.177 € for complex operations, including pars plana vitrectomie and pressure relieving operations. At two years follow-up keratoprosthesis surgery was considered morphologically successful in 30 eyes with good kerathoprosthesis integration and position. In two eyes the keratoprosthesis had to be removed during the two years of follow up. Visual acuity in these 30 patients was: >= 0,8 in 20% (N=6); Visus >=0,4 in 53% (N=15); Visus >=0,1 in 70 % (N=21); Visus <0,1 in 30% (N=9). Total quality of life improved significantly (p<0,001), with regards to daily activities 58, 73 and 81% of patients were able to read a newspaper, to recognize faces or to orientate in a room by visual means. CONCLUSION: OOKP is a complex and cost intensive procedure which requires extensive follow-up. Thanks to the high longterm retention rate of these keratoprosthesis and good functional results it leads to a significant improvement in quality of life and hence justifies the financial effort. KW - Soziale Kosten KW - Anpassungskosten KW - Blindheit KW - Lebensqualität KW - Augenkrankheit KW - Hornhaut KW - OOKP KW - Kerathoprothese KW - OOKP KW - Kerathoprosthesis Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-71245 ER -