Bimanual trabecular aspiration in pseudoexfoliation glaucoma: An alternative in nonfiltering glaucoma surgery1☆,
Section snippets
Instruments
For the bimanual technique of trabecular aspiration, the original irrigation-aspiration is modified in a way that separates the irrigation from the aspiration port and thereby reduces the outer diameter of the intracameral portion of the probe from 1.3 to 0.5 mm. The tip of the modified aspiration probe, which will get into contact with the trabecular tissue during surgery, remained unchanged. The opening of the aspirator still is 400-μm wide and horizontally angled at 45° to comply with the
Trabecular aspiration with cataract extraction
The glaucoma triple procedure group was comprised of 42 eyes of 36 patients (15 men, 21 women) in which bimanual trabecular aspiration with cataract extraction and IOL implantation was performed (Table 1). Ages at time of treatment ranged between 61 and 82 years (mean ± standard deviation [SD], 72.2 ± 5.9 years). There were no dropouts from follow-up (i.e., preoperative and postoperative data were available of all patients). Patients were observed for a minimum of 16 months and a maximum of 41
Discussion
The prognosis of pseudoexfoliation glaucoma generally is considered to be worse than primary open-angle glaucoma, because optic nerve head damage, visual field defects, and IOP levels are far more severe.4, 6, 8, 12, 13, 14, 19, 20, 21, 22, 23 Moreover, when compared with primary open-angle glaucoma, pseudoexfoliation glaucoma is known to respond less effectively to antiglaucomatous medication.23, 24, 25 Brinchmann-Hansen and associates25 examined the short-term response to topical medication
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Cited by (64)
Comparison of phacoemulsification parameters in eyes with and without exfoliation syndrome
2020, Journal Francais d'OphtalmologieCitation Excerpt :This finding can be explained by the surgeon knowing the fact that IOP reduction might be achieved after phacoemulsification of XFS eyes due to improvement in trabecular meshwork function by increasing access of aqueous humor to trabecular meshwork and the production of interleukin-1α and the removal of pigment and exfoliation material by anterior chamber lavage during surgery [18–21]. Jacobi et al cleared trabecular debris and pigment with a modified intraocular aspiration probe, which was called “trabecular aspiration”, to improve trabecular facility combined cataract extraction [20]. Moreover, since poor mydriasis in eyes with exfoliation is a common issue [3], this might have also challenge the irrigation and aspiration and required both more time and more fluid to remove all the cortex.
One-site Combined Surgery/Two-site Combined Surgery
2015, Glaucoma: Second EditionExfoliation Syndrome and Exfoliative Glaucoma
2015, Glaucoma: Second EditionAb interno trabeculectomy: Outcomes in exfoliation versus primary open-angle glaucoma
2012, Journal of Cataract and Refractive SurgeryCitation Excerpt :The authors hypothesize that this was the result of 1 or more of the following: deepening of the anterior chamber angle, reduction in the iridolenticular friction that releases pigment and exfoliation material, washout of exfoliation material, or low-grade inflammation that enhances aqueous outflow, similar to laser trabeculoplasty. In a small case series, Jacobi et al.5 evaluated the effects of trabecular I/A to remove trabecular exfoliation material in eyes with exfoliation glaucoma. Although they found a significant reduction in IOP, there was a 14% incidence of postoperative hematoma of the anterior chamber angle.
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Supported in part by Deutsche Forschungsgemeischaft, Germany; JA 717/3-1.
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The authors have no proprietary interests in the development or marketing of this or any competing piece of equipment.