Combined endoscopic erbium:YAG laser goniopuncture and cataract surgery.
OBJECTIVE
To study the safety and efficacy of endoscopic erbium:YAG (Er:YAG) laser goniopuncture combined with cataract surgery to treat glaucoma.


METHODS
Department of Ophthalmology, Albert-Ludwigs-University Freiburg, Freiburg, Germany, and Institute of Applied Physics, University of Bern, Bern, Switzerland.


METHODS
In this nonrandominized clinical trial, 20 eyes of 20 patients with cataract and glaucoma were treated by combined phacoemulsification and Er:YAG goniopuncture. The primary study endpoints were intraocular pressure (IOP), visual acuity, and number of antiglaucoma drugs 1 year after surgery. Two- and 3-year postoperative data were also measured. This prospective treatment arm was compared to a retrospective inclusion-matched control group treated by cataract surgery alone.


RESULTS
The mean IOP dropped by 30% (23.5 mm Hg +/- 3.9 [SD] to 16.3 +/- 2.7 mm Hg) after 12 months in the laser-treated group (P<.0001) and by 9% (19.8 +/- 1.3 mm Hg to 18.1 +/- 1.8 mm Hg) in the control group (P =.12). After 3 years, the mean IOP in the laser group was 15.0 +/- 2.0 mm Hg. The mean number of antiglaucoma drugs needed decreased from 1.6 +/- 0.9 to 0.5 +/- 0.8 in the laser group (P<.0001) and from 1.0 +/- 0.9 to 0.8 +/- 0.9 in the control group (P =.21). Anterior chamber hemorrhage occurred in 12 eyes after laser treatment and resolved within 72 hours in all but 1 patient who was on warfarin sodium (Coumadin) therapy. There were no cases of hypotony in either group.


CONCLUSIONS
Endoscopic Er:YAG laser goniopuncture was a successful adjunct to cataract surgery in glaucoma patients. Sustained IOP reduction was achieved with few postoperative complications.
Feltgen
Nicolas
N
Department of Ophthalmology, Albert-Ludwigs-University Freiburg, Bern, Switzerland.
Mueller
Heiko
H
Ott
Beat
B
Frenz
Martin
M
Funk
Jens
J
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002386:Cataract / Q000150:complications / Q000628:therapy*; D004724:Endoscopy; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D053685:Laser Therapy / Q000379:methods*; D019654:Lens Implantation, Intraocular; D018918:Phacoemulsification / Q000379:methods*; D011446:Prospective Studies; D012449:Safety; D014129:Trabecular Meshwork / Q000601:surgery; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity
D000959:Antihypertensive Agents