97th DOG Annual Meeting 1999
COMBINED CATARACT-GLAUCOMA SURGERY WITH DEEP SCLERECTOMY INSTEAD OF GONIOTREPHINATION IN THE INTRA- AND EARLY POSTOPERATIVE PHASE
A. Mohr , M. Rais , C. Eckardt
Introduction: Deep sclerectomy represents another surgical procedure in the therapy of glaucoma finding more and more acceptance. In refractive glaucoma and simultaneous cataract phacoemlsification with trabeculectomy is the most applied method . Since this procedure is accompanied with many undesired symptoms and therefore limited in its indication a surgical alternative would be welcomed. We examined if deep sclerectomy in combination with phacoemulsification is able to represent a usefull extension of the surgical armentarium in the intra- and postoperative phase concerning a lowered complication rate as well as a method in good postoperative IOP- regulation.
Patients: Totally in 12 patients we performed a combined deep sclerectomy with phacoemulsification. In 3 patients anterior chamber access was beneath the superior flap ( unilateral ). In 9 patients a separate clear cornea incision was done. The deep sclerectomy was carried out with deroofing of Schlemm´canal and an additional descemet´s window until a visible fistulation was seen. Subconjunctival fistulation was strived for. The mean postoperative follow-up time was 7.5 weeks (4-14 weeks). The results were compared with an earlier control group of 23 eyes in which a combined goniotrephination and phacoemulsification had been performed.
Results: Deep sclerectomy was more difficult to carry out than goniotrephination leading in 4 cases to a microperforation. Hyphema was seen in 25 % of all eyes but only in those patients who had unilateral anterior chamber access. Fibrine reaction was not observed neither hypotonic dysregulation ( IOP < 8 mm Hg ). Concerning the postoperative IOP - regulation 5 patients ( 41,6 % ) needed additional pressure lowering drugs.
Conclusion : The low inflammatory response in the early postoperative phase seems to justify the higher score in surgical difficulties as well as the prolonged operational time. Long term studies must proof if in contrast to the goniotrephination group the higher IOP level in the early postoperative phase meets the expectations in a good IOP regulation.
Community Eye Hospital of Frankfurt, Gotenstrasse 6-8 , 65929 Frankfurt-Hoechst