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Abstract #5490 Published in IGR 1-2
Goniocurettage for removing trabecular meshwork: clinical results of a new surgical technique in advanced chronic open-angle glaucoma.
Jacobi PC; Dietlein TS; Krieglstein GKAmerican Journal of Ophthalmology 1999; 127: 505-510
PURPOSE: To elucidate the long-term outcome of goniocurettage as a new technique in trabecular microsurgery for advanced open-angle glaucoma. METHODS: In a prospective, nonrandomized clinical trial, 25 eyes of 25 patients with a mean age ± SD of 72.7±10.1 years (range, 50 to 89 years) with uncontrolled chronic open-angle glaucoma that had undergone failed filtering procedures were treated by goniocurettage. Trabecular tissue was scraped away from the chamber angle by means of an instrument similar to a microchalazion curette (diameter, 300 microm). RESULTS: Before surgery, intraocular pressure ranged from 29 to 48 mmHg (mean ± SD, 34.7±7.1 mmHg), and mean number of antiglaucoma medications was 2.2±0.56. Follow-up averaged (±SD) 32.6±8.1 months (range, 30 to 45 months). Overall success, defined as postoperative intraocular pressure of 19 mmHg or less with one pressure-reducing agent, was attained in 15 eyes (60%), with five eyes (20%) being controlled without medication. Considering all successfully treated patients, the mean intraocular pressure was 17.7±3.1 mmHg (range, 10 to 19 mmHg) at the final visit. Mean intraocular pressure reduction was 17.1±7.1 mmHg in these eyes, representing a net decrease from baseline of 49%. Number of antiglaucoma medications dropped to 0.63±0.29. Complications included localized Descemet membrane detachment in five eyes (20%) and moderate anterior chamber bleeding in four eyes (16%). CONCLUSIONS: This new surgical technique can effectively control intraocular pressure for long periods of time in patients with open-angle glaucoma and a history of failed filtering procedures. Goniocurettage may be a suitable alternative to surgical treatment of glaucoma patients with excessive conjunctival scarification.
Department of Ophthalmology, University Eye Hospital Cologne, Germany.
Classification:
12.8.5 Other (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
