Long-term results of cataract surgery combined with trabeculotomy.
BACKGROUND
There are different surgical approaches for cataract and concomitant primary open-angle glaucoma (POAG). In a retrospective study we examined the long-term results of cataract extraction combined with trabeculotomy.


METHODS
Between 1990 and 1997, 194 eyes with cataract and POAG were operated on in a combined manner. Eighty-eight eyes received a trabeculotomy (TT), in 82 eyes a trabeculectomy was added to the trabeculotomy (TT+TE) and in 24 eyes, in which probing of Schlemm's canal was impossible, standard trabeculectomy (TE) was performed. Pre- and postoperative intraocular pressure (IOP), glaucoma medication, and the intra- and postoperative complications of all patients were analyzed.


RESULTS
Hyphema was the most common complication in the TT group (20.5%). Fibrin reaction occurred in 27.8% of all cases. There was no statistically significant difference in postoperative IOP between the TT group and the TT+TE group. A statistically significant decrease in IOP compared to preoperatively lasted 60 months in the TT group. In eyes with a preoperative IOP < or = 20 mmHg, none of the three procedures reduced IOP significantly (<20% of the preoperative IOP). In the first 2 years after operation 50% of the patients had no need for antiglaucomatous medication.


CONCLUSIONS
Cataract surgery combined with TT resulted in few complications. In low-tension glaucoma the combination with TT is not sufficient to decrease the IOP. In patients with higher preoperative IOP, however, cataract surgery combined with TT could be--on the basis of a postoperative observation time of 72 months--a suitable method for lowering the IOP sufficiently. Furthermore, the use of antiglaucomatous substances was reduced by this combined procedure.
Hoffmann
Esther
E
Department of Ophthalmology, Johannes Gutenberg University of Mainz, Germany. hoffmann@augen.klinik.uni-mainz.de
Schwenn
Oliver
O
Karallus
Matthias
M
Krummenauer
Frank
F
Grehn
Franz
F
Pfeiffer
Norbert
N
D000368:Aged; D002386:Cataract / Q000150:complications / Q000628:therapy*; D002387:Cataract Extraction / Q000379:methods*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity