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Long-term results of endotrabeculectomy in combined surgery of cataract and open-angle glaucoma

Poster Details

First Author: M.Novytskyy UKRAINE

Co Author(s):    I. Novytskyy              

Abstract Details



Purpose:

The aim is to study the hypotensive effect of endotrabeculectomy (trabecular ablation ab interno with forceps) in combination with phacoemulsification of cataract.

Setting:

The advantage of combined cataract and glaucoma surgeries consists in the radicalness of treatment, quick process of rehabilitation, absence of need for another surgical interference. A substantial disadvantage of the glaucoma surgeries with filtering bleb formation lies in the risk of obliteration of the newly formed outflow tracts with the loss of the hypotensive effect. Last years new technique of trabecula ablation ab interno has been developed. The unconditional demand for the surgery with excision of the trabecula lies in the evaluation of the level of retention of the intraocular fluid.

Methods:

There were 108 patients (126 eyes) with open-angle glaucoma and cataract who underwent endotrabeculoectomy and phaco under our supervision. 8 patients (8 eyes) underwent surgeries after non-effective previous glaucoma surgeries resulting in obliteration of the filtering tracts. Surgical technique. After intracameral 2% lidocain anesthesia clear corneal incision and two corneal paracentesis were made. Phaco with intracapsular IOL implantation was performed. Then anterior chamber was filled and deep with viscoelastic. Through one of paracentesis special designed forceps was inserted and under gonioscopic control trabecula was removed in the border of one or two quadrants. Viscoelastic was removed by irrigation-aspiration. Mean IOP before surgery was 19,2+/-1,5 mm Hg. The number of hypotensive drops that were used by the patients was 2.3+/-0.5. Reflux of blood into the Schlemm's canal has been provoked intraoperatively. Three degrees of the Shlemm's canal blood filling were estimated using the gonioscope. Hypotensive effect of the surgery was evaluated. Follow up period 24 months.

Results:

No blood filling of the Shlemm's canal was observed in 5 of the 131 eyes and was evaluated as contraindication for endotrabeculoectomy. These eyes were excluded from investigation. After endotrabeculectomy and aspiration of the viscoelastic, reflux of blood into the anterior chamber in the area of the excised trabeculum was observed in all cases, which was considered a positive prognostic of the surgery. IOP dropped in 7 days by 4.4+/-0.3 mmHg and equaled to 14.8+/-1.1 mmHg without application of drugs (p<0,001). In 1 month after the surgery, IOP was 15.2+/-1.2 mmHg, in 3 months - 15.4+/-1.2 mmHg. In 6 months after the surgery, IOP was 15.4+/-1.2 mmHg. Drop of IOP constituted 3.8+/-0.5 mmHg (20.3% of the initial). The number of hypotensive drops for achieving the targeted IOP in 6 months after the operation was 0.6+/-0.1. Absolute efficiency of the surgery was achieved in 72 cases out of 126. Relative efficiency of the surgery was registered in 45 cases out of 126. The surgery appeared inefficient in 9 cases out of 126. In 12, 18 and 24 months, IOP did not change and equaled to 15,3+/-1,1, 15,5+/-1,2 and 15,2+/-1,2 mmHg respectively.

Conclusions:

The long-term results of endotrabeculectomy prove the evident and stable hypotensive effect of the surgery. The intraoperative method of evaluation of the level of ocular fluid retention allows solving the issue of possible ablation of the trabeculum and evaluating the segment of its efficient ablation. FINANCIAL INTEREST: NONE

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