Phaco-trabeculotomy + deep sclerectomy a success

Phaco-trabeculotomy in addition to deep sclerectomy can offer significant reductions in intraocular pressure (IOP), according to a study published in the March issue of Acta Ophthalmologica Scandinavica.

Christoph Lüke and colleagues from the University of Cologne and the University of Tübingen, Germany examined a consecutive series of 15 patients with uncontrolled open-angle glaucoma and cataract undergoing combined glaucoma and cataract surgery. Phacoemulsifiaction and IOL implantation were conducted through a temporal incision in clear cornea. Trabeculotomy and deep sclerectomy were performed in the superior quadrant. Postoperative examinations were performed daily for one week and then one, three, six and 12 months after surgery.

Postoperative mean IOP at one day was significantly reduced to 14.2 mmHg whilst, at 12 months, the complete success rate, defined as <22 mmHg without medication, was 60%. Qualified success was achieved in 93.3% of subjects.

The mean number of anti-glaucoma medications fell to 0.4 (p<0.001) and visual acuity (VA) improved by a mean of 1.6 lines over baseline (p=0.021). Complications noted included choroidal de-roofing, inadvertent perforation of the trabeculo-descemetic membrane and non-identification of Schlemm's canal. The incidence of complications resulting from over-filtration was low but there was a relatively high incidence of hyphaemas (53%). All were trivial and quickly resolved and no severe complications were observed.

The authors believe that phaco-trabeculotomy and deep sclerectomy is able to provide significant IOP reductions whilst remaining a relatively safe procedure.