Abstract
Background
In the present study, the effectiveness of combined cataract surgery and ab interno trabeculectomy (Trabectome) in exfoliation glaucoma (PEX) was compared with combined cataract surgery and trabecular aspiration.
Methods
In this retrospective comparative cohort outcome study, 27 consecutive patients (mean age 73.41 years ± 10.78) in group 1 suffering from visually significant cataract and PEX glaucoma (mean preoperative IOP 23.41 mmHg ± 5.86) were treated with phacoemulsification combined with Trabectome; and 28 consecutive patients (73.83 years ± 8.94) were treated with phacoemulsification combined with trabecular aspiration (mean preoperative IOP 22.22 mmHg ± 6.33). The intraocular pressure (IOP) and the number of antiglaucoma eyedrops before and after surgery were evaluated.
Results
Examinations were performed prior to surgery, 1 day, 6 weeks, 3 months, 6 months, and 1 year after surgery. In both groups there was a statistically significant decrease in postoperative IOP during the whole follow-up period. Comparing the two groups, there was a statistically significant lower IOP in the Trabectome group 1 day (p = 0.019), 6 months (p = 0.025), and 1 year (p = 0.019) after surgery. Between the two groups, there was no statistically significant difference in the number of antiglaucoma eyedrops at any time.
Conclusions
Both procedures have the ability to significantly lower the postoperative IOP during the first year. However, clear cornea phacoemulsification combined with Trabectome seems to be more effective in IOP reduction in cases of PEX glaucoma associated with cataract.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ritch R (1994) Exfoliation syndrome. The most common identifiable cause of open angle glaucoma. J Glaucoma 3:176–178
Ritch R, Schloetzer-Schrehardt U (2001) Exfoliation syndrome. Surv Ophthalmol 45:266–315
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
Jacobi PC, Krieglstein GK (1995) Trabecular aspiration. A new surgical method for improving chamber angle facility in pseudoexfoliation glaucoma. Opthalmologe 92:550–555
Jacobi PC, Krieglstein GK (1995) Trabecular aspiration. A new mode to treat pseudoexfoliation glaucoma. Invest Ophthalmol Vis Sci 36:2270–2276
Jacobi PC, Dietlein T, Krieglstein GK (1998) Bimanual trabecular aspiration in pseudoexfoliation glaucoma; an alternative in nonfiltering glaucoma surgery. Ophthalmology 105:886–894
Ting JL, Damji KF, Stiles MC, Trabectome Study Group (2012) Ab internotrabeculectomy: outcomes in exfoliation versus primary open-angle glaucoma. J Cataract Refract Surg 38:315–323
Drolsum L, Ringvold A, Nicolaissen B (2007) Cataract and glaucoma surgery in pseudoexfoliative syndrome: a review. Acta Ophthalmol 85:810–821
Jacobi PC, Dietlein T, Krieglstein GK (1999) Comparative study of trabecularaspiration vs trabeculectomy in glaucoma triple procedure to treat pseudoexfoliation glaucoma. Arch Ophthalmol 117:1311–1318
Jea SY, Francis BA, Vakili G, Filippopoulos T, Rhee DJ (2012) Ab interno trabeculectomy versus trabeculectomy for open-angle glaucoma. Ophthalmology 119:36–42
Merkur A, Damji KF, Mintsioulis G, Hodge EG (2001) Intraocular pressure decrease after phacoemulsification in patients with pseudoexfoliation syndrome. J Cataract Refract Surg 27:528–532
Damji KF, Konstas AG, Liebmann JM, Hodge WG, Ziakas NG, Giannikakis S, Mintsioulis G, Merkur A, Pan Y, Ritch R (2006) Intraocular pressure following phacoemulsification in patients with and without exfoliation syndrome: a 2 year prospective study. Br J Ophthalmol 90:1014–1018
Shingleton BJ, Laul A, Nagao K, Wolff B, O’Donoghue, Eagan E, Flattern N, Desai-Bartoli (2008) Effect of phacoemulsification on intraocular pressure in eyes with pseudoexfoliation: single-surgeon series. J Cataract Refract Surg 34:1834–1841
Altan-Yaycioglu R, Canan H, Pelit A, Akova YA (2009) Intraocular pressure after phacoemulsification in eyes with pseudoexfoliation. J Cataract Refract Surg 35:952–954
Dietlein TS, Jordan J, Dinslage S, Lüke C, Krieglstein GK (2006) Early postoperative spikes of the intraocular pressure (IOP) following phacoemulsification in late-stage glaucoma. KlinMonatsbl Augenheilkd 223:225–229
Jampel HD, Musch DC, Gillespie BW, Lichter PR, Wright MM, Guire KE, Collaborative Initial Glaucoma Treatment Study Group (2007) Perioperative complications of trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Am J Ophthalmol 140:16–22
Gedde SJ, Herndon LW, Brandt JD, Budenz DL, Feuer WJ, Schiffman JC (2007) Surgical complications in the Tube Versus Trabeculectomy Study during the first year of follow-up. Am J Ophthalmol 143:23–31
Competing Interest
None to declare.
Author information
Authors and Affiliations
Corresponding author
Additional information
Matthias K. J. Klamann and Johannes Gonnermann joint first authors
Rights and permissions
About this article
Cite this article
Klamann, M.K.J., Gonnermann, J., Maier, AK.B. et al. Combined clear cornea phacoemulsification in the treatment of pseudoexfoliative glaucoma associated with cataract: significance of trabecular aspiration and ab interno trabeculectomy. Graefes Arch Clin Exp Ophthalmol 251, 2195–2199 (2013). https://doi.org/10.1007/s00417-013-2408-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-013-2408-2