COMPLICATIONS AND LONGTERM RESULTS OF COMBINED PHACO- TRABECULECTOMY WITH FOLDABLE POSTERIOR CHAMBER LENS
C.-D. Quentin, K. Dittmer, K. Lauritzen, M. Vogel
Background: Glaucoma patients which need filtering surgery have very often a cataract as well. But a combined glaucoma/cataract surgery can only be recommended if the possible increased rate of complications does not endanger the result of glaucoma surgery.
Patients and Methods: In a prospective study 172 eyes of 136 patients with uncontrolled glaucoma had filtering surgery and because of a cataract simultaneously phacoemulsification and implantation of a foldable posterior chamber lens. The history of glaucoma was between 1,6 to 36 years and the mean age of the patients 82.3 years (57 to 91 yrs).
Results: The follow up time ranged from 6 to 57 months (mean: 24.6 ms). The intraocular pressure (IOP) was lowered from 24.6 +/- 6.2 mm Hg to 16.4 +/- 3.2 mm Hg (p> 0.0001). The visual acuity improved from 0.27 (+/- 0.26) to 0.54 (+/- 0.25). Complications were preoperatively: chorioidal detachment (19x), fibrin reaction (14x), collaps of filtering bleb (9x), hyphaema (6x), zonolysis (4x), pupillary bloc (1x). Complications after 4 weeks were: seconday cataract with YAG capsulotomy (13x), shrinkage of rhexis (4x), corneal edema (1x) repeated glaucoma surgery (1x).
Conclusion: The complications of the combined procedure are mainly due to cataract surgery of glaucomatous eyes with narrow pupils and posterior synechia. Remarkably a shallow anterior chamber never occured. In spite of the complications the high success rate of lowering the IOP was comparable to the results of filtering surgery alone.
Univ.-Augenklinik, Robert-Koch-Str. 40, D-37075 Göttingen