96th DOG Annual Meeting, 1998

K17

LONG-TERM RESULTS OF COMBINED GLAUCOMA- AND CATARACT OPERATIONS: INTRAOCULAR PRESSURE AND VISUAL ACUITY FOLLOW-UP

J.M. Heisler, H.Venjakob, D. von Domarus, H. Wirt

Background: The co-existence of cataract and glaucoma requires a precise discussion of surgical management as there are different approaches. Retrospectively we compared two combined procedures i.e. Pham’s sclerectomy to Elliot’s trephining with scleral flap both combined with a phacoemulsification and implantation of a posterior chamber lens for their efficacy, reliability and prognosis.

Methods: Between 1994 and 1997, we performed Pham s sclerectomy in 65 eyes combined with a phacoemulsification and implantation of a posterior chamber lens (44 female, 21 male, mean age 76 + 10,6 years). At the same time we performed Elliot’s trephining with scleral flap in 65 eyes combined with a phacoemulsification and implantation of a posterior chamber lens (46 female, 19 male, mean age 76 + 8,1 years). The outcome was defined as an absolute success if a permanent postoperative lOP was < 21 mm Hg without any medication, as a relative success if a permanent postoperative IOP was < 21 mm Hg with medication and as a failure if the lOP was higher than the pre-op level or a second operation became necessary.

Results: In 93 % of the eyes which underwent Pam's sclerectomy the IOP measured after one weeks time was < 21 mm Hg without any medication. The long-term follow-up (mean time 18 months) 98% had a lOP < 21 mm Hg from which 30 % required an additional medication. The mean visual acuity increased by 2.2 lines. In 92 % of the eyes which underwent Elliot’s trephining with scleral flap the IOP measured after one weeks time was < 21 mm Hg without any medication. The long-term follow-up (mean time 25 months) 99 % had a IOP < 21 mm Hg from which 25 % required an additional medication. The mean visual acuity increased by 2.2 lines.

Conclusions: These findings demonstrate that fistulating operations belong to the most efficient and promising procedures to decrease the IOP. Considering the increasing influence of economical aspects combined glaucoma- and cataract operations are gaining wider importance.

Augenklinik des AK Barmbek, Rübenkamp 148, D-22291 Hamburg


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