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Abstract #8634 Published in IGR 5-1
Endoscopically controlled erbium:YAG goniopuncture versus trabeculectomy: effect on intraocular pressure in combination with cataract surgery
Feltgen N; Mueller H; Ott B; Frenz M; Funk JGraefe's Archive for Clinical and Experimental Ophthalmology 2003; 241: 94-100
PURPOSE: To compare the efficacy of endoscopic erbium:YAG laser goniopuncture in glaucoma treatment to trabeculectomy, both methods as adjuncts to cataract surgery. METHODS: Fifty-nine eyes of 59 glaucoma patients with coexistent cataract were treated by phacoemulsification and endoscopic Er:YAG goniopuncture in a combined fashion. The primary study endpoints were intraocular pressure (IOP), number of antiglaucomatous drugs, postoperative complications, hospitalization time and visual acuity at one year after surgery. To date, 24 eyes have finished the one-year follow-up. This prospective treatment arm was compared to a retrospective inclusion-matched control group treated by trabeculectomy and cataract surgery in a single procedure. RESULTS: In the laser-treated group, the mean IOP dropped by 30% from 23.4 ± 3.7 to 16.3 ± 6 mmHg (p < 0.0001) after 12 months. Without reoperation, treatment was successful in 71% of these eyes. In the control group, the IOP decreased by 33.5% from 22.7 ± 3.3 to 15.1 ± 3.8 mmHg (p < 0.0001). The success rate without reoperation was 46%. The number of antiglaucomatous drugs needed decreased from 1.48 ± 0.95 to 0.48 ± 0.7 (p < 0.0001) in the laser-treated group, and from 2.0 ± 0.9 to 0.39 ± 0.6 (p < 0.0001) in the control group. Postoperative complications were found more frequently in the control group (p < 0.0001). Hospitalization was shorter in the laser group (p < 0.0001). Postoperative visual acuity was lower in the control group (p = 0.004). CONCLUSIONS: Combined Er:YAG goniopuncture and cataract surgery lowers the IOP to an extent comparable to combined trabeculectomy and cataract surgery. Due to fewer postoperative complications, Er:YAG goniopuncture seems to be superior to standard fistulation surgery as the primary approach within the first year.
Dr. N. Feltgen, Department of Ophthalmology, Albert-Ludwigs University Freiburg, Killianstrasse 5, 79106 Freiburg, Germany. feltgen@aug.ukl.uni-freiburg.de
Classification:
12.14.3 Phacoemulsification (Part of: 12 Surgical treatment > 12.14 Combined cataract extraction and glaucoma surgery)
