Botz N., Heider W.

Augenklinik Herzog Carl Theodor, München

Background: The long-term intraocular pressure (IOP) reducing effect of combined cataract and glaucoma surgery is often of limited duration. The question is whether intraoperative factors are of any influence on it.
Methods: 300 eyes received simultaneous phacoemulsification and covered goniotrepanation at the same site. In a prospective study we recorded factors like: conjunctival thickness, adhesion of tenon´s capsule, amount of cauterization, position, form and thickness of the scleral flap, position of the trepanation, number of cut aqueous veins, number of stiches, IOP after filling the anterior chamber at the end of surgery, distance of scleral flap to conjunctival suture, stretching of the pupil, and synechiolysis. Perioperative factors like diabetes, allergies to eyedrops, history of glaucoma, treatment with IOP-lowering eyedrops (ED), axial lenght, anterior chamber depth (ACD), lens thickness, postoperative complications and argon-laser-suturelysis had been taken into account.
Results: Median follow-up was 23 months (8-45). IOP was lowered to 15.3 mmHg (±3,1), in patients without eyedrops (81%) to 15.1 mmHg (±2,9). The IOP-lowering effect was independent of the time distance to surgery. The intraoperative factors, lens thickness and ACD showed no influence on the long-term result. Of significant influence were duration of glaucoma and the number of preoperative ED. There was a tendency to higher long-term IOP in diabetics, thicker conjunctiva and intraoperative shallower anterior chamber and to lower IOP in allergic patients.
Conclusion: The intraoperative factors we examined showed no significant influence on the long-term IOP-lowering effect.

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