Combined cataract and glaucoma surgery: endoscope-controlled erbium:YAG-laser goniotomy versus trabeculectomy.
BACKGROUND
To compare endoscopic infrared laser trabecular ablation and trabeculectomy (both combined with cataract surgery) regarding intraocular pressure (IOP), visual acuity, anti-glaucomatous drugs and complications.


METHODS
Seventeen eyes of 14 patients [age 74.7+/-11.7 years (arithmetic mean +/- standard deviation)]-13 with primary open-angle glaucoma (POAG) and four with pseudoexfoliation glaucoma (PEXG)-underwent standard cataract surgery. After lens implantation, a probe (1.1 mm external diameter) with optic and laser fibres and an irrigation tube was introduced through the cataract incision. To perforate Schlemm's canal, 15-17 single pulses (16 mJ, 160 micros) were applied using a photo-ablative infrared laser (Er:YAG, lambda=2.94 microm). All eyes except one received antiglaucoma treatment. The control group treated with cataract surgery and trabeculectomy consisted of 17 eyes (13 POAG, four PEXG) of 15 patients (age 75.0+/-5.6 years), each eye received antiglaucoma treatment.


RESULTS
Mean follow-up was 3 years. The eyes treated with the endoscopic laser showed a mean preoperative IOP of 23.3+/-4.3 mmHg, which was reduced to 15.0+/-2.1 mmHg (mean IOP lowering 33.7%) after 3 years. Five eyes needed no medication for IOP-control after the procedure. Two eyes needed further surgery for IOP-control. In the control group, mean IOP was 24.5+/-2.6 mmHg in the beginning and 17.3+/-6.2 mmHg after 3 years, corresponding to a 33.3% lowering of IOP. Six eyes needed no medication, four eyes needed further surgery to lower IOP.


CONCLUSIONS
After 3 years follow-up of a small pilot group, combined endoscopic infrared laser surgery with cataract surgery seems to be a safe and effective way to lower IOP. It shows the same ability to lower IOP as combined cataract surgery with trabeculectomy. In addition, there are markedly less complications with the endoscope-controlled photo-ablative laser procedure.
Philippin
Heiko
H
Department of Ophthalmology, University of Freiburg, Killianstrasse 5, 79106 Freiburg, Germany. heiko.philippin@uniklinik-freiburg.de
Wilmsmeyer
Sonja
S
Feltgen
Nicolas
N
Ness
Thomas
T
Funk
Jens
J
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002386:Cataract / Q000150:complications / Q000628:therapy*; D004724:Endoscopy / Q000379:methods; D017889:Exfoliation Syndrome / Q000150:complications / Q000601:surgery*; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000601:surgery*; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure; D053685:Laser Therapy / Q000379:methods; D019654:Lens Implantation, Intraocular; D018918:Phacoemulsification / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D014130:Trabeculectomy / Q000379:methods*; D014792:Visual Acuity
D000959:Antihypertensive Agents