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Kombinierte Glaukom-Katarakt-Operation

Combined glaucoma-cataract surgery

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Zusammenfassung

Am häufigsten wird bei kombinierter Glaukom-Katarakt-Operation die Trabekulektomie angewendet, wobei die Erfolgsquote durch das Auftreten von Fibrinreaktionen eingeschränkt ist. Deshalb besteht derzeit die Tendenz, beide Eingriffe dann zu trennen, wenn keine dringlichen Aspekte eine sofortige kombinierte Operation erfordern. Die anderen zur Kombination mit einer Kataraktoperation empfohlenen Glaukomeingriffe sind die Trabekulotomie, die tiefe Sklerektomie, die Viskokanalostomie, die Trabekelaspiration und die Laser-Trabekelablation. Der drucksenkende Effekt ist zwar meist etwas geringer, die unmittelbare Komplikationsrate aber ebenfalls günstiger. Bei kombinierter Operation ist ein getrennter operativer Zugang mit „Clear-Cornea“-Phakoemulsifikation von temporal dem gemeinsamen Zugang etwas überlegen. Die Kernexpressionstechnik und der korneosklerale Zugang sind ungünstiger und sollten bei der kombinierten Glaukom-Katarakt-Operation keine Anwendung mehr finden.

Abstract

Trabeculectomy is the most commonly used glaucoma procedure for combined glaucoma-cataract surgery. The results are, however, challenged by rather frequent exudation of fibrin into the auterior chamber. Therefore, two separate procedures can be recommended if there is no urgent need for a combined glaucoma-cataract operation. The other glaucoma procedures that were described in combination with cataract surgery are trabeculotomy, deep sclerectomy, viscocanalostomy, trabecular aspiration, and laser trabecular ablation. The IOP lowering effect of these procedures seems somewhat less effective. However, there is also a lower complication rate. In combined procedures, a separate temporal clear cornea approach for phacoemulsification is superior to a one-site approach. Nuclear expression techniques and corneoscleral incisions should no longer be used in combined glaucoma-cataract surgery.

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Literatur

  1. Bobrow JC (2000) Prospective intrapatient comparison of extracapsular cataract extraction and lens implantation with and without trabeculectomy. Am J Ophthalmol 129:291–296

    Article  CAS  PubMed  Google Scholar 

  2. Borggrefe J, Lieb W, Grehn F (1999) A prospective randomized comparison of two techniques of combined cataract-glaucoma surgery. Graefes Arch Clin Exp Ophthalmol 237:887–892

    Article  CAS  PubMed  Google Scholar 

  3. Casson RJ, Salmon JF (2001) Combined surgery in the treatment of patients with cataract and primary open-angle glaucoma. J Cataract Refract Surg 27:1854–1863

    Article  CAS  PubMed  Google Scholar 

  4. Diestelhorst M (1999) Combined cataract and glaucoma surgery. Ophthalmologe 96:54–69

    Article  CAS  PubMed  Google Scholar 

  5. El-Sayyad F, Helal M, El-Maghraby A, Khalil M, El-Hamzawey H (1999) One-site versus 2-site phacotrabeculectomy: a randomized study. J Cataract Refract Surg 25:77–82

    CAS  PubMed  Google Scholar 

  6. El-Sayyad FF, Helal MH, Khalil MM, El-Maghraby MA (1999)Phacotrabeculectomy versus two-stage operation: a matched study. Ophthalmic Surg Lasers 30:260–265

    CAS  PubMed  Google Scholar 

  7. Feltgen N, Mueller H, Ott B, Frenz M, Funk J (2003) Combined endoscopic erbium:YAG laser goniopuncture and cataract surgery. J Cataract Refract Surg 29:2155–2162

    Article  PubMed  Google Scholar 

  8. Feltgen N, Mueller H, Ott B, Frenz M, Funk J (2003) Endoscopically controlled erbium:YAG goniopuncture versus trabeculectomy: effect on intraocular pressure in combination with cataract surgery. Graefes Arch Clin Exp Ophthalmol 241:94–100

    PubMed  Google Scholar 

  9. Friedman DS, Jampel HD, Lubomski LH et al. (2002) Surgical strategies for coexisting glaucoma and cataract: an evidence-based update. Ophthalmology 109:1902–1913

    Article  PubMed  Google Scholar 

  10. Funk J, Feltgen N, Asbeck D (2000) Intraocular pressure reduction by endoscopically controlled erbium:YAG goniotomy. Ophthalmologe 97:473–477

    Article  CAS  PubMed  Google Scholar 

  11. Georgiadis N, Boboridis K, Halvatzis N, Ziakas N, Moschou V (2003) Low-dose tissue plasminogen activator in the management of anterior chamber fibrin formation. J Cataract Refract Surg 29:729–732

    Article  PubMed  Google Scholar 

  12. Georgopoulos GT, Chalkiadakis J, Livir-Rallatos G, Theodossiadis PG, Theodossiadis GP (2000) Combined clear cornea phacoemulsification and trabecular aspiration in the treatment of pseudoexfoliative glaucoma associated with cataract. Graefes Arch Clin Exp Ophthalmol 238:816–821

    Article  CAS  PubMed  Google Scholar 

  13. Gianoli F, Schnyder CC, Bovey E, Mermoud A (1999) Combined surgery for cataract and glaucoma: phacoemulsification and deep sclerectomy compared with phacoemulsification and trabeculectomy. J Cataract Refract Surg 25:340–346

    CAS  PubMed  Google Scholar 

  14. Gimbel HV, Penno EE, Ferensowicz M (1999) Combined cataract surgery, intraocular lens implantation, and viscocanalostomy. J Cataract Refract Surg 25:1370–1375

    Article  CAS  PubMed  Google Scholar 

  15. Grehn F (1995) The value of trabeculotomy in glaucoma surgery. Curr Opin Ophthalmol 6:52–60

    Google Scholar 

  16. Hoffmann E, Schwenn O, Karallus M, Krummenauer F, Grehn F, Pfeiffer N (2002) Long-term results of cataract surgery combined with trabeculotomy. Graefes Arch Clin Exp Ophthalmol 240:2–6

    PubMed  Google Scholar 

  17. Jacobi PC, Dietlein TS, Krieglstein GK (1999) Comparative study of trabecular aspiration vs trabeculectomy in glaucoma triple procedure to treat pseudoexfoliation glaucoma. Arch Ophthalmol 117:1311–1318

    CAS  PubMed  Google Scholar 

  18. Jacobi PC, Dietlein TS, Krieglstein GK (2000) The risk profile of trabecular aspiration versus trabeculectomy in glaucoma triple procedure. Graefes Arch Clin Exp Ophthalmol 238:545–551

    Article  CAS  PubMed  Google Scholar 

  19. Jampel HD, Friedman DS, Lubomski LH et al. (2002) Effect of technique on intraocular pressure after combined cataract and glaucoma surgery: An evidence-based review. Ophthalmology 109:2215–2224

    Article  PubMed  Google Scholar 

  20. Klink J, Schmitz B, Lieb WE, Klink T, Grein H-J, Sold-Darseff J, Heinhold A, Grehn F (2004) Filtering bleb function after clear cornea phacoemulsification—a prospective study, submitted

  21. Krommes G, Lieb W, Grehn F (2002) Standardization of the dose of intraoperative mitomycin C in trabeculectomy. Graefes Arch Clin Exp Ophthalmol 240:594–595

    CAS  PubMed  Google Scholar 

  22. Marquardt D, Lieb WE, Grehn F (2004) Intensified postoperative care versus conventional follow-up: a retrospective long-term analysis of 177 trabeculectomies. Graefes Arch Clin Exp Ophthalmol 242:106–113

    Article  PubMed  Google Scholar 

  23. McPherson SD (1977) Combined trabeculotomy and cataract extraction as a single operation. Trans Am Ophthalmol Soc 74:250–260

    Google Scholar 

  24. Mietz H, Andresen A, Welsandt G, Krieglstein GK (2001) Effect of cataract surgery on intraocular pressure in eyes with previous trabeculectomy. Graefes Arch Clin Exp Ophthalmol 239:763–769

    CAS  PubMed  Google Scholar 

  25. Mohr A, Rais M, Eckardt C (2001) Combined cataract-glaucoma surgery with deep sclerectomy. An alternative to gonio-trephination in the intra- and early postoperative phases. Ophthalmologe 98:253–257

    Article  CAS  PubMed  Google Scholar 

  26. Park M, Tanito M, Nishikawa M, Hayashi K, Chichara E (2004) Combined viscocanalostomy and cataract surgery compared with cataract surgery in Japanese patients with glaucoma. J Glaucoma 13:55–61

    Article  PubMed  Google Scholar 

  27. Rockwood EJ, Larive B, Hahn J (2000) Outcomes of combined cataract extraction, lens implantation, and trabeculectomy surgeries. Am J Ophthalmol 130:704–711

    Article  CAS  PubMed  Google Scholar 

  28. Schwenn O, Grehn F (1995) Cataract extraction combined with trabeculotomy. Ger J Ophthalmol 4:16–20

    CAS  PubMed  Google Scholar 

  29. Storr-Paulsen A, Bernth-Petersen P (2001) Combined cataract and glaucoma surgery. Curr Opin Ophthalmol 12:41–46

    CAS  PubMed  Google Scholar 

  30. Tanihara H, Negri A, Akimoto M, Nagata M (1995) Long-term surgical results of combined trabeculotomy ab externo and cataract extraction. Ophthalmic Surg 26:316–324

    CAS  PubMed  Google Scholar 

  31. Tanito M, Ohira A, Chihara E (2001) Surgical outcome of combined trabeculotomy and cataract surgery. J Glaucoma 10:302–308

    Article  CAS  PubMed  Google Scholar 

  32. Tanito M, Park M, Nishikawa M, Ohira A, Chihara E (2002) Comparison of surgical outcomes of combined viscocanalostomy and cataract surgery with combined trabeculotomy and cataract surgery. Am J Ophthalmol 134:513–520

    Article  PubMed  Google Scholar 

  33. Tanito M, Ohira A, Chihara E (2002) Factors leading to reduced intraocular pressure after combined trabeculotomy and cataract surgery. J Glaucoma 11:3–9

    Article  PubMed  Google Scholar 

  34. Urban V, Kammann MT, Sturmer JP (2000) Glaucoma and cataract: combined operation or trabeculectomy first and cataract extraction later? Klin Monatsbl Augenheilkd 216:105–111

    Article  CAS  PubMed  Google Scholar 

  35. Vass C, Menapace R (2004) Surgical strategies in patients with combined cataract and glaucoma. Curr Opin Ophthalmol 15:61–66

    Article  CAS  PubMed  Google Scholar 

  36. Wishart MS, Shergill T, Porooshani H (2002) Viscocanalostomy and phacoviscocanalostomy: long-term results. J Cataract Refract Surg 28:745–751

    Article  PubMed  Google Scholar 

  37. Wyse T, Meyer M, Ruderman JM, Krupin T, Talluto D, Hernandez R, Rosenberg LF (1998) Combined trabeculectomy and phacoemulsification: a one-site vs a two-site approach. Am J Ophthalmol 125:334–339

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Augenklinik, Universität, Würzburg

    F. Grehn & T. Klink

  2. Augenklinik, Universität, Josef-Schneider-Straße 11, 97080 , Würzburg

    F. Grehn

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  1. F. Grehn
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  2. T. Klink
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Correspondence to F. Grehn.

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Grehn, F., Klink, T. Kombinierte Glaukom-Katarakt-Operation. Ophthalmologe 101, 661–666 (2004). https://doi.org/10.1007/s00347-004-1042-0

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  • DOI: https://doi.org/10.1007/s00347-004-1042-0

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