Long Term Results of Trabecular Aspiration in the Treatment of Pseudoexfoliative Glaucoma

Abstract

Abstract: : Purpose: In the present prospective randomized study the long term effect in IOP control of trabecular aspiration combined with clear cornea phacoemulsification was compared to clear cornea phacoemulsification alone in patients with pseudoexfoliation (PEX) glaucoma and cataract. Methods: Twenty-seven patients suffering from visually significant cataract (visual acuity < 5 Snellen lines) and PEX glaucoma were randomly assigned to either phacoemulsification combined with trabecular aspiration (14 eyes of 14 patients) or phacoemulsification alone (13 eyes of 13 patients). Inclusion criteria for glaucoma were IOP ≤ 22 mmHg under treatment with up to two antiglaucomatous agents except pilocarpine 4%, and no previous surgery or laser trabeculoplasty treatment. Clear cornea phacoemulsification with foldable acrylic intraocular lens (IOL) implantation was carried out in all patients uneventfully. Trabecular aspiration was performed using a special probe in the inferior 180 degrees of the angle after IOL implantation. Results: Follow-up time ranged from 48 to 54 months (mean 51,7 months). At the last recorded examination (range 48 to 54 months) the mean IOP was lower in the combined procedure group (16,1 ± 1,46 mmHg) than in the phaco alone group (17, 3 ± 1,25 mmHg) but the difference was not statistically significant (p = 0.068). Comparing the two groups there was a statistically significant decrease in the postoperative medications used in the combined procedure group at the last recorded examination (p = 0.032). Conclusions: It seems that the combined clear cornea phaco and trabecular aspiration procedure in cases of PEX glaucoma associated with cataract, is a safe and effective method. This technique controls better IOP and with less postoperative medications than clear cornea phaco alone.

Keywords: clinical (human) or epidemiologic studies: tre • trabecular meshwork • intraocular pressure