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ViscotrabeculectomyM. Löw, C. Bühler, U. Mester
Background: Particularly early postoperative complications as flat anterior chamber, anterior chamber hemorrhage, ciliary block, and choroidal detachment can reduce the long term success of glaucoma filtration surgery. The purpose of our investigation was to investigate the efficacy of a viscoelastic (Healon ® ) in trabeculectomy and phacotrabeculectomy in preventing these complications.
Methods: 114 eyes of 95 consecutive patients underwent trabeculectomy (TE) between August 1998 and September 1999. 74 out of the 114 eyes received combined phacotrabeculectomy with IOL-implantation (Phaco-TE). In all cases Healon ® was instilled at the beginning and left in the anterior chamber at the end of surgery. First IOP assessment was performed after 4 hours. Minimal follow up was 3 months.
Results: The average IOP 4 hours postoperatively was 9.9 mmHg (TE) and 7.8 mmHg (Phaco-TE). After 3 months follow up the average IOP was 16.4 mmHg (TE) and 15.6 mmHg (Phaco-TE) respectively. Postoperative complications were limited to blood remnants in the anterior chamber in 2 eyes (5.0%) after TE, respectively 3 eyes (4.0%) after Phaco-TE. A mild fibrin reaction was observed in 7 eyes after phacotrabeculectomy only. Choroidal detachment or ciliary block did not occur.
Conclusions: The intraoperative application of Healon ® in trabeculectomy and phacotrabeculectomy without removal of the viscoelastic at the end of surgery lowers the risk of postoperative complications significantly, thus improving the long term results also. With respect to the effective IOP-reduction of trabeculectomy and the minimized complication rate by using viscoelastics, this operation seems be still up-to-date.
Department of Ophthalmology, Bundesknappschafts Hospital, An der Klinik 10, D-66280 Sulzbach