97th DOG Annual Meeting 1999



N. Wakili, J. Hayler, A. Händel, P. Martus

The purpose of this retrospective, cross-sectional, clinical study was to analyse the impact of the type of glaucoma and the type of surgical approach during cataract surgery on the progression of glaucoma in patients with cataract surgery (C-OP) after filtering operation (F-OP).

Patients and Methods: In 100 eyes of 100 patients (52 females, 48 males, age at the time of C-OP 72±9 years, age at the time of F-OP 67±8 years) the following parameters were analysed: visual acuity, intraocular pressure (IOP), E/P ratio and mean defect (MD) of 30º computerized perimetry before F-OP, before C-OP and on averge 33±21 months after C-OP. 54 eyes with primary open angle glaucoma (OAG), 42 eyes with secondary open angle glaucoma in pseudoexfoliation syndrome (PEX) and 4 eyes with other types of secondary open angle glaucoma were included. The maximum IOP was 28.7±8.8 mmHg in OAG and 34.0±8.2 mmHg in PEX. 95 trabeculectomies were performed without Mitomycin-C and 5 trabeculectomies with Mitomycin-C. In 67 patients the C-OP approach was via ²clear cornea² (CC) and in 33 patients the approach was via a corneoscleral tunnel (CST) (61 superior, 18 superior temporal, 18 temporal and 3 superior nasal cut).

Results: Comparing CC/CST the visual acuity before F-OP was 0.64±0.33/0.67±0.27, before C-OP 0.25±0.18/0.25±0.17 and after C-OP 0.42±0.27/ 0.49±0.35. The IOP was 24.6±9.5/26.3±8.2 mmHg, 15.7±6.2/16.6±6.1 mmHg (>21 mmHg 20%/18%) and 15.3±4.8/16.4±4.9 mmHg (>21 mmHg 10%/4%). The E/P ratio was 0.8±0.2/0.8±0.2, 0.8±0.2/0.9±0.2 and 0.8±0.2/0.9±0.2, the MD was 13.8±6.1/13.6±8.1, 16.1±6.5/15.8±7.2 and 16.1±6.3/14.7±8.4. Comparing OAG/PEX the visual acuity before F-OP was 0.57±0.33/0.71±0.29, before C-OP 0.25±0.12/0.23±0.15 and after C-OP 0.4±0.29/0.51±0.27. The IOP was 22.5±7.4/25.9±9.1 mmHg, 15.2±5.9/ 16.8±6.1 mmHg (>21 mmHg 11%/28%) and 15.1±4.5/16.9±5.3 mmHg (>21 mmHg 4%/18%). The E/P ratio was 0.8±0.2/0.8±0.2, 0.8±0.2/0.8±0.1 and 0.9±0.2/0.8±0.2. The MD was 14.6±6.6/13.6±7.1, 17.6±6.7/15.1±5.7 and 17.5±5.9/14.9±7.7.

Conclusions: Our results indicate that secondary cataract surgery after filtering operation has no clinically relevant impact on the progression of the underlying glaucoma. In particular, neither the approach for cataract surgery nor the type of glaucoma seem to influence the glaucoma specific parameters.

Department of Ophthalmology, University of Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen