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Advances in Endoscopic Glaucoma Surgery
Funk J., Feltgen N., Müller H., Wilmsmeyer ,
Albert-Ludwigs-Universität Freiburg, Augenklinik (Freiburg)
Introduction: The basic principles of glaucoma surgery are 1) reduction of aqueous humor formation in the ciliary body or 2) improvement of aqueous humor outflow through the trabecular meshwork. Both anatomic sites, ciliary body and trabecular meshwork, can be directly visualized using an endoscope system.
Method: A reduction of aqueous humor formation can be achieved by endoscopic cyclophotocoagulation. Endoscopic cyclophotocoagulation is performed with the same thermal diode laser which is usually applied in conventional transscleral cyclophotocoagulation. The endoscopic approach allows a very precise localising and dosing of the laser beam. An improvement of aqueous humor outflow can be obtained by endoscopic trabecular ablation, either with an Er:YAG laser (Er:YAG goniotomy) or with an 308 nanometer excimer laser (ELT=excimer laser trabeculotomy). Endoscopic trabecular ablation stands out for very rare complications and the potential of treating difficult cases (i. e. pemphigoid, opaque corneae).
Results: Some studies in the literature reported extremely high successrates for endoscopic cyclophotocoagulation, yielding up to 65% intraocular pressure reduction. Our own experience with this technique is not so much overwhelming. Endoscopic trabecular ablation is performed in our clinic since more than three years. Patients who completed the three year follow up still show a 30% reduction in intraocular pressure. Up to know there is no trend towards a decrease of the pressure lowering efficacy.
Conclusions: Endoscopic cyclophotocoagulation is a valuable procedure in worst glaucoma cases. Endoscopic trabecular ablation, however, seems to be an alternative to filtering surgery as a primary procedure or in combination with cataract surgery.