Kraft J., Lieb W. E., Grein H. J., Schmitz B., Heinold A., Grehn F.

Universitätsaugenklinik, Josef-Schneider-Str.11, D-97080 Würzburg

Purpose: To evaluate the influence of clear cornea phacoemulsification on filtering bleb morphology, function and intraocular pressure (IOP) in glaucoma eyes with previously successful filtering surgery.
Method: We prospectively evaluated the clinical course of 30 patients (30 eyes) that underwent clear cornea phacoemulsification after previous successful filtering glaucoma surgery. Mean intraocular pressure and filtering bleb morphology (standardized assessment criteria and score 0-20, 20=optimum) were determined before surgery, 3 days, 6 month and 12 month after surgery. The control group contained 31 patients with glaucoma after clear cornea phacoemulsification without previous filtering surgery.
Results: Mean IOP increased after phacoemulsification by about 2mmHg (preoperatively 14.28 ±3.71 mmHg, 12 month post-op 16.33 ±3.31 mmHg, p=0.006). 15 patients (50%) showed an IOP increase of >2mmHg, 11 patients (36.7%) had no IOP-difference, in 4 patients IOP decreased >2mmHg. Mean score of filtering bleb morphology one year after surgery decreased from 17.9 to 14.8. In 3 of 30 preoperative IOD-regulated eyes the postoperative IOD was > 21mmHg. The control group showed an average IOP decrease of 2.2mmHg (p=0.005) 12 month after cataract surgery.
Conclusion: We found an increase in IOP one year after phacoemulsification in half of the filtered glaucoma eyes. IOP in glaucoma eyes without previous filtering surgery decreased in the same period. Cataract extraction using clear cornea phacoemulsification may be associated with a partial loss of the previously functioning filter and with an impairment of filtering bleb morphology.

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