Elsevier

Ophthalmology

Volume 105, Issue 5, 1 May 1998, Pages 886-894
Ophthalmology

Bimanual trabecular aspiration in pseudoexfoliation glaucoma: An alternative in nonfiltering glaucoma surgery1,

https://doi.org/10.1016/S0161-6420(98)95032-1Get rights and content

Abstract

Objective

The primary cause of intraocular pressure (IOP) elevation in pseudoexfoliation glaucoma is obstruction of the intertrabecular spaces by exfoliation material. Previously, the authors reported on a new concept of nonfiltering glaucoma surgery—trabecular aspiration—designed to increase trabecular outflow in pseudoexfoliation glaucoma. In the current study, a description of the modified instrument, its refined surgical technique, and longterm clinical results will be given to substantiate the efficacy of trabecular aspiration in the surgical management of pseudoexfoliation glaucoma.

Study design

The study design was a prospective and nonrandomized study.

Participants

A total of 68 eyes of 54 patients suffering from medically uncontrolled pseudoexfoliation glaucoma were treated by bimanual trabecular aspiration. Thirty-four eyes of 28 pseudoexfoliative patients treated by standard trabeculectomy constituted the control group.

Intervention

Trabecular debris and pigment were cleared with a suction force of 100 to 200 mmHg under light tissue-instrument contact using a modified intraocular aspiration probe. The aspiration cannula is 400 μm in diameter and horizontally angulated at 45°. Irrigation of the anterior chamber was performed via a separate irrigation cannula.

Main outcome measures

The IOP and number of medications before and after surgery were measured.

Results

In 42 eyes of 36 patients, trabecular aspiration was performed in combination with cataract extraction and lens implantation. The IOP dropped from 32.4 ± 7.2 mmHg (range, 23–52 mmHg) under maximal tolerated medical therapy before surgery to 18.7 ± 1.7 mmHg (range, 16–23 mmHg) at 2 years after surgery, with 54% of patients being controlled without medication. In 22 eyes of 19 patients, trabecular aspiration was performed as primary surgical intervention. The IOP dropped from 31.3 ± 7.1 mmHg (range, 23–42 mmHg) before surgery to 16.8 ± 3.4 mmHg (range, 12–23 mmHg) at 18 months after surgery, with 45% of patients not taking medication.

Conclusions

Bimanual trabecular aspiration is safe and efficacious in decreasing IOP both with and without cataract extraction in pseudoexfoliation glaucoma. However, there seems to be a slight regression in effect over time attributed to undisturbed liberation of exfoliative debris. Argon-laser trabeculoplasty before trabecular aspiration reduces the IOP-lowering effect of this procedure. A prospective, randomized, multicenter study is warranted to finally assess the potential of trabecular aspiration in pseudoexfoliation glaucoma.

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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    Supported in part by Deutsche Forschungsgemeischaft, Germany; JA 717/3-1.

    1

    The authors have no proprietary interests in the development or marketing of this or any competing piece of equipment.

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