NON-PENETRATING EXTERNAL TRABECULAR INCISION, A THERAPEUTICALY CONCEPT IN CHRONIC OPEN ANGLE GLAUCOMA PATIENTS
J. Schmidt, C. Wilkens, G.W. Nietgen
Background: Multiple postoperative problems with regular trabeculectomy surgery like decreased IOP, a flat anterior chamber, bleeding, choroideal detachments and consecutively cystic, nonfiltrating release pouches made this new technique attractive in our search for alternative procedures. Since 1997 we increasingly use this non-penetrating trabecular excision technique to better regulate pressure gradients from the anterior chamber towards the created release pouch.
Methods: In this prospective study we operated 15 patients since June 1997 (l1 females, 4 males). All patients presented with chronic open angle glaucomas. We performed a modified, non-penetrating excision into the trabecular meshwork. Follow-up period ranges from 1 to 6 months (mean 2.3 months).
Results: In 13 eyes intraoccular pressure could be controlled through this procedure, decreasing IOP here below 20 mm Hg. In two eyes with continuing pressures above 20 mm Hg a second surgery with penetrating trabeculectomy was performed. No eye showed a decrease in visual function after surgery, a flattened and hypotonic anterior chamber, decreased IOP, choroideal detachment or a cystic release pouch.
Conclusions: Low rates of complications and a good management of this procedure may be in long term a reasonable alternative to the conventional procedure of the penetrating goniotrepanations. One reason for two unsuccessful surgeries in the beginning of our series was probably a too shallow opening of the trabecular meshwork.
Department of Ophthalmology, Philipps University, 35037 Marburg, Germany