Combined clear cornea phacoemulsification in the treatment of pseudoexfoliative glaucoma associated with cataract: significance of trabecular aspiration and ab interno trabeculectomy
BACKGROUND The main reason for elevation of intraocular pressure (IOP) in glaucoma capsulare is secondary plugging of the intertrabecular spaces by pigment and fibrillous material. The goal of this study was to evaluate the clinical results of trabecular aspiration, a new surgical concept to improve trabecular facility in glaucoma capsulare. METHODS Trabecular aspiration was performed under the operating microscope prior to extracapsular cataract extraction (ECCE) in half of the chamber angle circumference, using a specially designed irrigation-aspiration device in 27 glaucomatous eyes. The hand-held instrument has three outlets, one for aspiration (400 microns wide and 45 degrees horizontally angulated to meet the slope of the meshwork) and two (650 microns) for irrigation to maintain a deep anterior chamber and to keep the iris away from suction. Trabecular debris and pigment was cleared with a suction force of 100-200 mmHg. RESULTS The mean preoperative IOP (with and without glaucoma therapy) was 31.6 +/- 7.2 mmHg; At different times after operation, IOP values were: day 5, 15.1 +/- 4.2 mmHg. 1 month, 17.5 +/- 3.2 mmHg; 3 months, 17.2 +/- 2.5 mmHg; 6 months, 17.5 +/- 2.6 mmHg; 12 months, 21 +/- 4.5 mmHg. The mean antiglaucomatous medication score decreased from 3.81 medications/day preoperatively to 0.52 medications/day 12 months postoperatively. CONCLUSIONS In a limited number of patients suffering from pseudoexfoliative glaucoma and cataract, the IOP-lowering effect of trabecular aspiration in combination with ECCE could be substantiated. Removal of inter- and pretrabecular debris prior to ECCE decreased IOP by 44% from baseline (12-month results), which indicates clinical relevance.