Endoscopically controlled erbium:YAG goniopuncture versus trabeculectomy: effect on intraocular pressure in combination with cataract surgery.
OBJECTIVE
. To compare the efficacy of endoscopic erbium:YAG laser goniopuncture in glaucoma treatment to trabeculectomy, both methods as adjuncts to cataract surgery.


METHODS
. Fifty-nine eyes of 59 glaucoma patients with coexistent cataract were treated by phacoemulsification and endoscopic Er:YAG goniopuncture in a combined fashion. The primary study endpoints were intraocular pressure (IOP), number of antiglaucomatous drugs, postoperative complications, hospitalisation time and visual acuity at 1 year after surgery. To date, 24 eyes have finished the 1-year follow-up. This prospective treatment arm was compared to a retrospective inclusion-matched control group treated by trabeculectomy and cataract surgery in a single procedure.


RESULTS
. In the laser-treated group, the mean IOP dropped by 30% from 23.4+/-3.7 mmHg to 16.3+/-6 mmHg ( P<0.0001) after 12 months. Without reoperation, treatment was successful in 71% of these eyes. In the control group, the IOP decreased by 33.5% from 22.7+/-3.3 mmHg to 15.1+/-3.8 mmHg ( P<0.0001). The success rate without reoperation was 46%. The number of antiglaucomatous drugs needed decreased from 1.48+/-0.95 to 0.48+/-0.7 ( P<0.0001) in the laser-treated group and from 2.0+/-0.9 to 0.39+/-0.6 ( P<0.0001) in the control group. Postoperative complications were found more frequently in the control group ( P<0.0001). Hospitalisation was shorter in the laser group ( P<0.0001). Postoperative visual acuity was lower in the control group ( P=0.004).


CONCLUSIONS
. Combined Er:YAG goniopuncture and cataract surgery lowers the IOP to an extent comparable to combined trabeculectomy and cataract surgery. Due to fewer postoperative complications, Er:YAG goniopuncture seems to be superior to standard fistulation surgery as the primary approach within the first year.
Feltgen
Nicolas
N
Department of Ophthalmology, Albert-Ludwigs University Freiburg, Killianstrasse 5, 79106 Freiburg, Germany. feltgen@aug.ukl.uni-freiburg.de
Mueller
Heiko
H
Ott
Beat
B
Frenz
Martin
M
Funk
Jens
J
D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications; D004724:Endoscopy / Q000379:methods; D017889:Exfoliation Syndrome / Q000150:complications / Q000601:surgery; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D053685:Laser Therapy / Q000379:methods*; D008875:Middle Aged; D018918:Phacoemulsification; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D014129:Trabecular Meshwork / Q000601:surgery*; D014130:Trabeculectomy / Q000379:methods*; D014792:Visual Acuity