Background: The success rate of combined glaucoma and small incision cataract surgery is not yet established.

Regulation of intraocular pressure after combined glaucoma and cataract surgery

Chirurgie der Glaukome

Fragestellung: In dieser Studie wurden die langfristigen Verlaufe von Augeninnendruck und Visus nach kombinierten Glaukom-Katarakt-Operationen uberpruft. 
Patienten und Methode: Bei 65 Augen wurde in den Jahren 1994 bis 1997 eine Sklerektomie nach Pham und bei einem gleichgrosen Patientenkollektiv eine gedeckte Trepanation nach Elliot durchgefuhrt. Beide Operationsverfahren wurden mit einer Phakoemulsifikation und Hinterkammerlinsenimplantation kombiniert. Der mittlere Nachbeobachtungszeitraum betrug 21,9±11,0 Monate. 
Ergebnisse: Der IOD bei den Patienten, die nach der Sklerektomie operiert wurden, konnte praoperativ von 21,4±3,3 mm Hg auf postoperativ 14,9±2,7 mm Hg und bei den Patienten, die nach der gedeckten Trepanation operiert wurden von 24,6±7,3 mm Hg auf 15,8±2,6 mm Hg gesenkt werden. 30% der Patienten, die nach der Sklerektomie und 25% der Patienten, die nach der gedeckten Trepanation operiert wurden, benotigten postoperativ eine zusatzliche medikamentose drucksenkende Therapie. Beide Operationsmethoden verbesserten den Visus im Durchschnitt um 3 Visusstufen. 
Schlusfolgerung: Diese Daten zeigen, das kombinierte Operationen zur Senkung des IOD und zur Verbesserung des Visus zu erfolgreichen Eingriffe zahlen. Besonders unter den heutigen okonomischen Aspekten erhalten einzeitige Glaukom-Katarakt-Operationen eine zunehmende Bedeutung.

Langzeitergebnisse kombinierter Glaukom-Katarakt-Operationen Augendruck und Visus im Verlauf

Fragestellung.Uberpruft wurde der Langzeiterfolg nach primarer Goniotrepanation mit Skleradeckel fur das primare kongenitale Glaukom (PKG). 
Patienten und Methode. Retrospektiv wurde der Erfolg der primaren Goniotrepanation mit Skleradeckel bei 31 Augen von 18 Patienten mit PKG analysiert. Der Operationserfolg wurde folgendermasen definiert: Intraokulardruck unter 18 mmHg ohne zusatzliche Medikamentengabe, Stabilisierung oder Reduktion des horizontalen Hornhautdurchmessers und Stabilisierung oder Regression der glaukomatosen Exkavation. Auch das Auftreten postoperativer Komplikationen wurde verfolgt. 
Ergebnisse. Die Nachbeobachtungszeit betrug 10–161 Monate (im Mittel 63 Monate)). Bei 25 Augen konnte das PKG mit einer Goniotrepanation reguliert werden (Erfolgsrate: 80,6%), bei 31 Augen waren 2 Goniotrepanationen erforderlich (Erfolgsrate: 100%). Es wurden keine ernsteren postoperativen Komplikationen beobachtet. 
Schlussfolgerung. Die primare Goniotrepanation mit Skleradeckel ist eine erfolgreiche und sichere Methode zur Behandlung des PKG.

Primäres kongenitales Glaukom Langzeiterfolg nach primärer Goniotrepanation mit Skleradeckel

Goniotrepbination is a surgical procedure applied by many ophthalmologists in glaucoma with good results. Its favourable assessment has been based on observations covering no more than a five-year postoperative period. The evaluation, however, of any surgical procedure can be more strictly tested and thus better validated by a more prolonged period of observation. 108 eyes operated on were followed-up closely for ten or more years. The following information retrieved from the patients’ records were studied: indication to operate, preoperative IOP, postoperative IOP after ten or more years, need of conservative treatment postoperatively, bleb morphology and its relation to the IOP values, fate of the visual function, etc. These observations did not substantially change the early statisfactory assessment of the results that have been published to date.

Long-Term Observations on Goniotrephination

In the introduction, the principles and limitations of modern glaucoma surgery are described. There then follow some personal observations on the history of goniotrepanation, from which it is evident that the scleral flap is not the invention of any single surgeon, but rather the result of experiments by several. The importance of the scleral flap was proved by the almost simultaneous appearance of trabeculectomy and goniotrepanation and, some time later, of Schleie's covered fistulizing operation. The technical details of goniotrepanation and the features peculiar to this procedure are then described. It follows from this description that goniotrepanation is a microsurgical procedure demanding skill and experience on the part of the surgeon. Comparative studies of goniotrepanation in the literature are then discussed in detail. These are concerned with postoperative findings, pressure regulation, morphological changes at the site of the operation and the effect on visual function. The advantages of goniotrepanation and the function of the parathalamus, which represents a new drainage path for the aqueous, are then described. The procedure creates a normal balance between the quantity of aqueous produced and its drainage to the exterior, resulting in a normalization of intraocular pressure. This drain does not lead directly to the subconjunctival space, but indirectly, via normal pathways, through the parathalamus formed by the flap. The creation of the parathalamus can be useful in glaucoma surgery; it offers advantages as regards both indication and surgical technique.

Goniotrepanation using scleral flap in modern surgery of glaucoma

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Goniotrepanation using scleral flap in modern surgery of glaucoma