Trabecular aspiration: clinical results of a new surgical approach to improve trabecular facility in glaucoma capsulare.

The main reason for elevated intraocular pressure (IOP) in glaucoma capsulare is secondary plugging of the intertrabecular spaces by pigment and fibrillous material. The goal of this study was to evaluate the clinical results of "trabecular aspiration," a new surgical technique designed to improve trabecular facility in pseudoexfoliative glaucoma (PEG). Trabecular aspiration was performed under the operating microscope prior to extracapsular cataract extraction (ECCE) over half of the chamber-angle circumference using a specially designed irrigation-aspiration device in 12 eyes diagnosed with PEG and cataract. Trabecular debris and pigment were cleared with a suction force of 100 to 200 mm Hg. The mean preoperative IOP (with and without antiglaucoma medications) was 33.0 +/- 6.27 mm Hg; on postoperative day 5, 16.25 +/- 4.5 mm Hg; at 1 month, 18.1 +/- 2.68 mm Hg; at 3 months, 18.33 +/- 2.69 mm Hg; and at 6 months, 19.0 +/- 6.26 mm Hg. The mean number of antiglaucoma medications per day decreased from 3.77 preoperatively to 0.67 at 6 months postoperatively. Trabecular aspiration substantially lowered the IOP in all 12 patients. Removal of intertrabecular and pretrabecular debris prior to ECCE reduced IOP 42% from baseline at 6 months postoperatively, a clinically significant decrease. Additionally, routine preoperative and postoperative gonioscopy in most cases revealed a significant reduction of pigmentation in the area of treatment. More patients and longer follow up are required to substantiate these results.