Combined cataract and glaucoma surgery: endoscope-controlled erbium:YAG-laser goniotomy versus trabeculectomy

Background To compare endoscopic infrared laser trabecular ablation and trabeculectomy (both combined with cataract surgery) regarding intraocular pressure (IOP), visual acuity, antiglaucomatous drugs and complications.Methods Seventeen eyes of 14 patients age 74.7±11.7 years (arithmetic mean ± standard deviation)]—13 with primary open-angle glaucoma (POAG) and four with pseudoexfoliation glaucoma (PEXG)—underwent standard cataract surgery. After lens implantation, a probe (1.1 mm external diameter) with optic and laser fibres and an irrigation tube was introduced through the cataract incision. To perforate Schlemms canal, 15–17 single pulses (16 mJ, 160 s) were applied using a photoablative infrared laser (Er:YAG, =2.94 m). All eyes except one received antiglaucoma treatment. The control group treated with cataract surgery and trabeculectomy consisted of 17 eyes (13 POAG, four PEXG) of 15 patients (age 75.0±5.6 years), each eye received antiglaucoma treatment.Results Mean follow-up was 3 years. The eyes treated with the endoscopic laser showed a mean preoperative IOP of 23.3±4.3 mmHg, which was reduced to 15.0±2.1 mmHg (mean IOP lowering 33.7%) after 3 years. Five eyes needed no medication for IOP-control after the procedure. Two eyes needed further surgery for IOP-control. In the control group, mean IOP was 24.5±2.6 mmHg in the beginning and 17.3±6.2 mmHg after 3 years, corresponding to a 33.3% lowering of IOP. Six eyes needed no medication, four eyes needed further surgery to lower IOP.Conclusions After 3 years follow-up of a small pilot group, combined endoscopic infrared laser surgery with cataract surgery seems to be a safe and effective way to lower IOP. It shows the same ability to lower IOP as combined cataract surgery with trabeculectomy. In addition, there are markedly less complications with the endoscope-controlled photoablative laser procedure.The authors have no proprietary interest in the techniques used. This study was presented in part at the 101st meeting of the Deutsche Ophthalmologische Gesellschaft (DOG), Berlin, 2003.