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Surgical Glaucoma Managment in Germany - Results of a Questionnaire Survey

Lieb W., Zeitz A., Grehn F.,
Bayerische Julius-Maximilians-Universität Würzburg, Universitäts-Augenklinik (Würzburg)

Introduction: In the last decades several modifications of surgical techniques have been advocated for glaucoma surgery. To find out how this surgical techniques are being utulized in daily practise we established a questionaire. In order to find out what surgical procedures are utilized for primary open angle glaucoma, angle closure glaucoma and pediatric glaucomas in Germany at this time.
Material and methods: A standardized questionaire was sent to more than 2000 ophthalmologists on outpatient surgical centers, eye hospitals and university eye departments in Germany. Ophthalmic surgeons were ask to answer questions regarding frequency of glaucoma patients, of glaucoma procedures and anaesthesia for glaucoma surgery. A total of 383 questionaires were completely filled out and were available for analysis. 248 outpatient surgeons and 174 eye departments answered.
Results: 3/4 of the responding surgeons are working in outpatient surgery centers. 1/4 is working at eye departments in a communal or university setting. Whereas in outpatient surgery centers the ammount of glaucoma operations accounts for 1 to 2% of the total surgical volume. In hospitals the percentages of glaucoma patients is higher between 5 and 10%. The majority of antiglaucomatous operations were performend in peri- or retrobulbar anaesthesia, but 1/3 under general anaesthesia. In primary angle closure glaucoma the YAG-iridotomy is the therapy of choice of 63% of surgeons. In primary or secondary open angle glaucoma trabeculectomy and trabeculotomy and cyclodestructive procedures predominate. In outpatient surgery centers trabeculotomy and viscocanalostomy are the primary procedures of choice.
Conclusions: In Germany still trabeculectomy and cyclodestructive procedures are standard for difficult glaucomas. There is a trend to non-penetrating and chamber angle procedures. Woundhealing modifying substances are being used by 1/3 glaucoma surgeons.