Long-term results of viscocanalostomy in pseudoexfoliative and primary open angle glaucoma.
OBJECTIVE
To document the outcome of viscocanalostomy (VC) alone or combined with phacoemulsification (phaco-VC) in eyes with pseudoexfoliation glaucoma (PEXG) and primary open angle glaucoma (POAG).


METHODS
A prospective, comparative study of 314 eyes undergoing VC in two centres over 6 years was conducted. Main outcome measures were: (i) intraocular pressure (IOP) control (complete success was IOP < or = 18 mmHg without medication and failure IOP > 18 mmHg); and (ii) requirement for Nd:YAG laser goniopuncture (YAG-GP) if IOP > 21 mmHg.


RESULTS
In the POAG group, 174 eyes underwent phaco-VC and 104 VC. In the PEX group, 20 eyes underwent phaco-VC and 16 VC. At final follow up, complete success rate (CSR) was 76% for POAG phaco-VC, 67% for POAG VC, 95% for PEXG phaco-VC and 63% for PEXG VC with mean IOP reduction of 29.9%, 40%, 42.5% and 51%, respectively. Without YAG-GP, by 3 years postoperatively the failure rate was 100% for PEXG eyes and 21% for POAG eyes undergoing VC alone, but PEXG eyes undergoing phaco-VC were 100% successful. CSR for YAG-GP was 92% in PEXG VC eyes and 55% in POAG VC eyes.


CONCLUSIONS
In phakic eyes with PEXG undergoing VC, an absolute requirement for long-term success was YAG-GP. This was not the case in POAG eyes or PEXG eyes undergoing phaco-VC. Late IOP rise in phakic PEXG eyes and restoration of IOP control following YAG-GP suggests that continued release of PEX material from the lens capsule with time blocks the outflow through the trabecular-Descemetic window created by VC.
Wishart
Peter K
PK
St. Paul's Eye Unit, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK. peter.wishart@rlbuht.nhs.uk
Wishart
Manijeh S
MS
Choudhary
Anshoo
A
Grierson
Ian
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003886:Descemet Membrane / Q000601:surgery*; D017889:Exfoliation Syndrome / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D018463:Filtering Surgery / Q000379:methods*; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D014129:Trabecular Meshwork / Q000601:surgery*; D016896:Treatment Outcome