International Ophthalmology

, Volume 38, Issue 6, pp 2341–2347 | Cite as

The effect of additional trabecular aspiration to phacoemulsification and trabectome as a triple procedure in pseudoexfoliation glaucoma: a case-matched study

  • R. A. WidderEmail author
  • J. F. Jordan
  • P. Kühnrich
  • J. Luebke
  • G. F. Roessler
  • A. Anton
Original Paper



Trabectome surgery combined with phacoemulsification is effective in lowering (intraocular pressure) IOP in pseudoexfoliation glaucoma. Trabectome surgery usually aims to remove two to four clock hours of the trabecular meshwork. When adding trabecular aspiration, the remaining meshwork can be treated as well, and therefore 360 degrees of the meshwork can be reached. This study was conducted to investigate the additional benefits and risks of adding trabecular aspiration to the combination of phacoemulsification and trabectome as a triple procedure.


Two groups of patients from two centres were compared. The first group underwent phacoemulsification and trabectome (Freiburg), and the second group underwent additional trabecular aspiration (Düsseldorf). Using a case-matched retrospective study design, 50 patients were included into each group. The clinical endpoint was the intraocular pressure at follow up.


The mean follow up was 22 months. Mean intraocular pressure decreased in all 100 patients from 25.0 (SD 4.3) to 14.9 mmHg (SD 4.0). Comparing the two groups, the IOP reduction was from 25.0 (SD 5.0) to 14.1 (SD 4.4) mmHg in the triple procedure group compared to a reduction from 25.0 (3.6) to 15.7 (SD 3.4) mmHg in the phaco/trabectome group. The difference was statistically significant (p = 0.03). The number of medication after surgery was reduced from 2.2 (SD 0.9) to 1.7 (SD 0.9) while in the phaco/trabectome group the medication score was reduced from 2.2 (SD 1.0) to 1.1 (SD 0.1) (p < 0.001).


This study shows that the combination of trabectome surgery and phacoemulsification leads to a clinically significant reduction of IOP over several years in patients with pseudoexfoliation glaucoma. The addition of trabecular aspiration as a triple procedure results in further lowering of IOP without causing more side effects. This finding might be biased by the higher medication score in the triple procedure group.


Trabectome Trabecular aspiration Pseudoexfoliation glaucoma Glaucoma surgery 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study (retrospective), formal consent is not required.


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Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  • R. A. Widder
    • 1
    Email author
  • J. F. Jordan
    • 2
    • 3
  • P. Kühnrich
    • 1
  • J. Luebke
    • 2
  • G. F. Roessler
    • 1
  • A. Anton
    • 2
  1. 1.Department of OphthalmologySt. Martinus-Krankenhaus DüsseldorfDüsseldorfGermany
  2. 2.Eye Center, Medical CenterUniversity of FreiburgFreiburgGermany
  3. 3.Eye Center Vobig and JordanFrankfurtGermany

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