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Abstract #11887 Published in IGR 7-1
Viscocanalostomy and non-penetrating trabecular surgery with and without cataract extraction for open-angle glaucoma in a caucasian population
Milauskas ATClinical and Surgical Ophthalmology 2004; 22: 360-365
PURPOSE: To evaluate the results of the traditional Stegmann type of viscocanalostomy and that of a non-penetrating trabecular surgery (NPTS) in a California Caucasian population. METHODS: 28 eyes of 25 patients (9 female, 16 male), average age 79, had viscocanalostomy performed. 11 patients had associated phacoemulsification of their cataract through a temporal incision with the placement of a foldable IOL. A later series of 46 eyes (41 patients) had an NPTS with the use of five 5-fluorouracil-soaked pledgets under the conjunctiva to prevent bleb fibrosis. 25 eyes had associated phacoemulsification of their cataract through a temporal incision with a foldable IOL. RESULTS: In the viscocanalostomy series, the average follow-up was 16 months (range, 12 to 36). Preoperative average intraocular pressure (IOP) was 23.3 mmHg while the postoperative IOP was 18.1 mmHg. The number of preoperative medications was 2.78 versus 0.57 postoperatively. Of the 28 patients, 16 developed blebs, 2 of which shrunk. Of the patients with blebs, only 3 needed medications to control IOP to < 21 mmHg. Of the 12 eyes that did not form blebs, 5 were controlled without medication. 3 of the combined cataract patients needed medications and 3 developed blebs. In the NPTS series of patients, there were 46 eyes of 41 patients (20 male and 21 female), average age 75.8 years, average follow-up 11.2 months (range, 1 to 24.6). The mean preoperative IOP was 20.7 mmHg and the postoperative IOP was 14.3 mmHg. The average number of preoperative medications was 3.1 and postoperatively, 0.4. 33/46 (71.7%) eyes were controlled with no medications ( < 21 mmHg). 39/46 (84%) were controlled with O to 1 medications and 45/46 (95%) were controlled with O to 3 medications. In the combined procedure eyes, the mean IOP was 20.7 mmHg preoperatively and 14.4 mmHg postoperatively. The number of preoperative medications was 2.8 and postoperatively 0.2. Mean follow-up was 10.9 months (range, 1 to 24.6). 21/25 eyes (84%) maintained an IOP of < 20 mmHg on no medications. CONCLUSIONS: Viscocanalostomy, as described by Stegmann, failed to effectively reduce IOP in our Caucasian population with advanced glaucoma who had previously been treated with multiple medications and Argon laser trabeculoplasty (ALT). 59% of the eyes developed blebs. The procedure was modified with more encouraging results, maintaining the use of a deep sclerectomy to generate a non-perforated trabeculo-Descemet's window but to allow filtration to occur through the superficial scieral flap into the subconjunctival space.
Dr. A.T. Milauskas, 555 E. Tachevah Drive, Palm Springs, CA 92262, USA
Classification:
12.8.3 Non-perforating (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
