{"id":117911,"date":"2018-03-11T10:47:38","date_gmt":"2018-03-11T10:47:38","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/estudio-del-endotelio-corneal-y-de-la-presion-intraocular-en-pacientes-intervenidos-de-glaucoma-y-catarata-en-uno-o-dos-tiempos\/"},"modified":"2018-03-11T10:47:38","modified_gmt":"2018-03-11T10:47:38","slug":"estudio-del-endotelio-corneal-y-de-la-presion-intraocular-en-pacientes-intervenidos-de-glaucoma-y-catarata-en-uno-o-dos-tiempos","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/oftalmologia\/estudio-del-endotelio-corneal-y-de-la-presion-intraocular-en-pacientes-intervenidos-de-glaucoma-y-catarata-en-uno-o-dos-tiempos\/","title":{"rendered":"Estudio del endotelio corneal y de la presi\u00f3n intraocular en pacientes intervenidos de glaucoma y catarata en uno o dos tiempos"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Mar\u00eda  Isabel Soro Martinez <\/strong><\/h2>\n<p>Objetivos determinar los cambios en la morfolog\u00eda y la disminuci\u00f3n de la densidad de  c\u00e9lulas endoteliales corneales tras la cirug\u00eda de glaucoma y catarata en uno \u00f3 dos tiempos, y analizar cu\u00e1l de los dos tipos de cirug\u00eda produce mayor da\u00f1o endotelial.   determinar la disminuci\u00f3n de la presi\u00f3n intraocular tras la cirug\u00eda de glaucoma y catarata en uno \u00f3 dos tiempos y analizar cu\u00e1l de los dos tipos de cirug\u00eda produce una mayor disminuci\u00f3n de la presi\u00f3n intraocular y\/o mayor estabilidad de \u00e9sta en el postoperatorio.  material y m\u00e9todos este es un estudio prospectivo randomizado y aleatorizado realizado en 46 ojos de 39 pacientes, con edad comprendida entre 66 y 80 a\u00f1os que padec\u00edan glaucoma y catarata. Los pacientes fueron seleccionados aleatoriamente para ser intervenidos de trabeculectom\u00eda y facoemulsificaci\u00f3n con implante de lente intraocular (lio) en uno (grupo 1) o dos tiempos (grupo 2), despu\u00e9s de dar su consentimiento informado. Se recogieron de los pacientes varios tipos de datos: demograf\u00eda, mejor agudeza visual corregida, evaluaci\u00f3n del endotelio corneal mediante microscopia confocal (confoscan 4\u00c2\u00bf), medici\u00f3n del espesor corneal mediante biometr\u00eda ultras\u00f3nica (ocuscan\u00c2\u00bf),  medida de la profundidad de la c\u00e1mara anterior con un bi\u00f3metro \u00f3ptico (iolmaster\u00c2\u00bf). Los pacientes fueron examinados previamente a la cirug\u00eda y 3, 6, 12 y 24 meses tras la cirug\u00eda.  El an\u00e1lisis estad\u00edstico se llev\u00f3 a cabo mediante el software minitab\u00c2\u00bf siguiendo los est\u00e1ndares publicados en la literatura cl\u00ednica. resultados la mejor agudeza visual corregida aument\u00f3 de forma significativa en los dos grupos despu\u00e9s de la cirug\u00eda (p&lt;0,0001) y la presi\u00f3n intraocular disminuy\u00f3 de forma significativa en los dos grupos tras la cirug\u00eda (p&lt;0,0001) pero no se observaron diferencias significativas (p=0,568 al mes, p=0,629 a los tres meses, p=0,208 a los seis meses y p=0,838 a los doce meses) entre los grupos en ninguno de los tiempos estudiados. El n\u00famero medio de f\u00e1rmacos hipotensores t\u00f3picos se redujo de 1,21\u00c2\u00b10,55 a 0,20\u00c2\u00b10,43 colirios en el grupo 1 y 1,26\u00c2\u00b10.2 a 0,25\u00c2\u00b10,46 colirios en el grupo 2 a los 12 meses del estudio, no existiendo diferencias estad\u00edsticamente significativas (p=0,704) entre los dos grupos. La densidad endotelial disminuy\u00f3 de forma significativa en ambos grupos tras la cirug\u00eda (p&lt;0,0001). La densidad endotelial a los 12 meses de la cirug\u00eda fue de 1.769\u00c2\u00b1 509 c\u00e9lulas\/mm2 en el grupo 1 y  de 1.396\u00c2\u00b1514 c\u00e9lulas\/mm2  en el grupo 2, siendo esta diferencia estad\u00edsticamente significativa (p&lt;0,0001). El porcentaje medio de reducci\u00f3n de c\u00e9lulas endoteliales fue de 31,62\u00c2\u00b114,73 % en el grupo 1 y de 42,55\u00c2\u00b117,68 % en el grupo 2 a los 12 meses de estudio. El coeficiente de variaci\u00f3n celular no vari\u00f3 de forma significativa en ninguno de los dos grupos tras la cirug\u00eda, sin embargo el coeficiente de hexagonalidad disminuy\u00f3 de forma significativa en el grupo 2. No se encontr\u00f3 una correlaci\u00f3n significativa entre la disminuci\u00f3n de la densidad de c\u00e9lulas endoteliales y la profundidad de la c\u00e1mara anterior preoperatoria ni tampoco entre esta densidad y el espesor corneal central previo a la cirug\u00eda en ninguno de los grupos, aunque tampoco se observaron edemas corneales cl\u00ednicamente significativos en ninguno de los ojos incluidos en el estudio.   summary in english  objectives to assess changes in morphology and density of the corneal endothelial cells after glaucoma and cataract surgery in one or two stages and to analyze which type of surgery causes most damage to the corneal endothelial cells. to assess the decrease of the intraocular pressure after glaucoma and cataract surgery in one or two stages and to analyze which type of surgery causes a greater decrease of the intraocular pressure and more stability of the intraocular pressure in the postoperative period. methods this is a randomized prospective cohort study that included 46 eyes with glaucoma and cataract from 39 patients aged between 66 and 80 years. Informed consent was obtained, after which the patients and were randomly assigned to receive trabeculectomy and phacoemulsification and intraocular lens (iol) implantation in one (group 1) or two stages (group 2). Demographic as well as other parameters were determined: best corrected visual acuity (bcva), corneal endothelial cell status (using confocal microscopy with the confoscan 4\u00c2\u00bf), central corneal thickness (using ultrasonic biometry ocuscan\u00c2\u00bf) and anterior chamber depth (using optic biometry iolmaster\u00c2\u00bf). Patients were assessed prior to surgery and 3,6,12 and 24 months after surgery. Statistical analysis was performed using the software minitab\u00c2\u00bf and published international clinical standards. results \tbest corrected visual acuity increased significantly in both groups after surgery (p&lt;0.0001) and the intraocular pressure diminished significantly in both groups after surgery (p&lt;0.0001), but there were not significant differences between groups at any of the periods studied (at one month, p=0.568; at three months, p=0.629; at six months, p=0.208;  and at twelve months, p=838). Mean number of topical ocular hypotensive treatments diminished from 1.21\u00c2\u00b10.55 to 0.20\u00c2\u00b10.43 in group 1 and from 1.26\u00c2\u00b10.2 to 0.25\u00c2\u00b10.46 in group 2 twelve months after surgery and there were no significant differences between groups (p=0.704). Corneal endothelial cell density decreased significantly after surgery in both groups (p&lt;0.0001). Endothelial cell density 12 months after surgery was 1,769\u00c2\u00b1 509 cells\/mm2 in group 1 and 1,396\u00c2\u00b1514 cells\/mm2 in group 2, and this difference was statistically significant (p&lt;0.0001). Mean percentage of decrease of corneal endothelial cells was 31.62\u00c2\u00b114.73% in group 1 and 42.55\u00c2\u00b117.68% in group 2, twelve months after surgery. The variation coefficient did not change significantly in any of the groups with surgery, but the hexagonality coefficient decreased significantly after surgery in group 2. There was no significant correlation between the decrease of the endotelial cell densities and the preoperative anterior chamber depth or the preoperative central corneal thickness in any of the groups. However, we did not observe any clinically significant corneal edemas in any of the eyes included.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Estudio del endotelio corneal y de la presi\u00f3n intraocular en pacientes intervenidos de glaucoma y catarata en uno o dos tiempos<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Estudio del endotelio corneal y de la presi\u00f3n intraocular en pacientes intervenidos de glaucoma y catarata en uno o dos tiempos <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Mar\u00eda  Isabel Soro Martinez <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 17\/07\/2015<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Jaime Miralles De Imperial Mora Figueroa<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: julian Garcia sanchez <\/li>\n<li>consuelo L\u00f3pez abad (vocal)<\/li>\n<li>josefa Mar\u00eda Vinuesa silva (vocal)<\/li>\n<li>Alberto Trivi\u00f1o casado (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Mar\u00eda Isabel Soro Martinez Objetivos determinar los cambios en la morfolog\u00eda y la disminuci\u00f3n de la densidad 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