gms | German Medical Science

Purpose: To compare hypotensive effect of two antiglaucoma technologies combined with phacoemulsification in terms of 5 to 6 years.

Methods: Retrospective analysis of two groups with primary glaucoma and cataract. Group I - phacoemulsification with IOL implantation and microinvasive non-penetrating deep sclerectomy (85 eyes of 83 patients). Age was from 53 to 86 (mean, 70 ± 0.7) years; 36 males and 47 females. 67 (57%) patients were on antiglaucoma medications. Preoperative IOP was from 21 to 38 mm Hg (mean, 30 ± 0.86 mm Hg), visual acuity was from light perception to 0.5 (mean, 0.17 ± 0.11). Group II - phacoemulsification with IOL implantation and ab internо trabeculotomy (87 eyes of 86 patients). Age was from 61 to 88 (mean, 72 ± 0.8) years; 35 males and 51 female. 71 (62%) patients were on antiglaucoma medications. Preoperative IOP was from 22 to 41 mm Hg (mean, 26.8 ± 0.8 mm Hg), visual acuity was from light perception to 0.5 (mean, 0.19 ± 0.02).

Results: Patients were observed on day 3, months 1, 6, 12, 24, 36, 48, 60, 72 after surgery. Mean follow up was 65 ± 7.1 months. Complications in group I: hypertension at first day - 16 cases (19%), hypotension - 8 (9%), exudative reaction- 10 (12%) Complications in group II: hypertension at first day - 8 cases (9.3%), exudative reaction- 6 (7%), hyphema - 16 (18.6%). Changes of IOP and visual acuity were as follows. Group I: at day 3 after surgery mean IOP was 20.4 ± 3.2 mm Hg, mean visual acuity 0.55 ± 0.11; one month - 23.6 ± 2.6 and 0.58 ± 0.18; six months - 17.3 ± 3.4, 0.59 ± 0.17; sixty months - 21.1 ± 2.7, 0.58 ± 0.14. Medications were used in 7 (8%) eyes. Laser goniopuncture was performed in 73% of cases (62 eyes) in terms of 1 to 72 months. 5 eyes (5.9%) later underwent glaucoma surgery of other types. Group II: on day 3 after surgery mean IOP was 18.7 ± 3.2 mm Hg, mean visual acuity 0.56 ± 0.11; one month - 17.3 ± 2.6 and 0.66 ± 0.18; six months - 19.2 ± 3.4, 0.53 ± 0.17; sixty months - 19.9 ± 2.7, 0.49 ± 0.14. Medications were used in 12 (14%) eyes. 7 eyes (8%) of I group later underwent glaucoma surgery of other types.

Conclusion: The introduced technology provides high hypotensive effect and visual acuity improvement in patients with glaucoma and cataract. Hypotensive effect of trabeculotomy ab interno in the observation period of more than 5 years (5 to 6 years) was comparable with microinvasive non-penetrating deep sclerectomy, and unlike the latter, does not require additional surgical steps such as laser goniopuncture.