O. Arend, C. Redbrake, S. Arend, K. Huber, A. Remky, M. Wenzel

Aim: In this examination the rate of complications and the efficiacy concerning target pressure following combined procedure of catarct extraction and trabeculotomy was assessed in glauoma patients before surgery and after one year follow-up

Methods: Cataract extraction was performed through a modified Frown tunnel. From the incision in the opposite direction a deep scleral flap is choosen to identify Schlemm canal. After gonioscopic control Schlemm‘ s canal After lens extraction the Schlemm‘s canal is opened (Wenzel et al. Ophthalmo-Chirurgie 1997). Prospectively, 31 patients (n=38 eyes: n=19 primary open angle glaucoma; n=6 narrow angle glaucoma with chronic congestion; n=10 pseudoexfoliation glaucoma; n=3 secondary glaucoma) were examined before surgery and after 1 year follow-up.

Results: The mean age was 75 years (± 8 years) and the mean follow-up period was 313 ±50 days. The intraocular pressure (IOP) was significantly lowered (p<0.001) from 27 ±7 mmHg to 15,1 ±5 mmHg after one year. The criteria of reduced IOP below 21 mmHg was reached in 90% of the patients (34 of 38 eyes). The target pressure dependent on severity of glaucoma (acc. To H. Jampel) was reached in 60% (22 of 38 eyes). The pre and post surgical visual acuity was not significantly different. The pre operative lens thickness (A scan mode) was unrelated to the lowering of IOP. In none of the patients a postoperative hypotony or filtering bleb was seen, however, in 30% (11 of 38 eyes) posterior synechia occured. The mean number of antiglaucomatous drugs was significantly lowered vom 1.4 to 0.4.

Conclusion: The combined cataract extraction and trabeculotomy proofed to be a secure and efficient IOP lowering procedure. In contrast to the combination with fistulating surgery the possibility of immediate antiglaucomatous drug application and independency of postsurgical tissue scaring seems positive.

Dept of Ophthalmology, RWTH Aachen, Pauwelsstr. 30, D-52057 Aachen, Germany

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