Jacobi P C, Dietlein T S, Krieglstein G K
University of Cologne, Department of Ophthalmology, Germany.
Ophthalmology. 1998 May;105(5):886-94. doi: 10.1016/S0161-6420(98)95032-1.
The primary cause of intraocular pressure (IOP) elevation in pseudoexfoliation glaucoma is obstruction of the intertrabecular spaces by exfoliation material. Previously, the authors reported on a new concept of nonfiltering glaucoma surgery-trabecular aspiration-designed to increase trabecular outflow in pseudoexfoliation glaucoma. In the current study, a description of the modified instrument, its refined surgical technique, and long-term clinical results will be given to substantiate the efficacy of trabecular aspiration in the surgical management of pseudoexfoliation glaucoma.
The study design was a prospective and nonrandomized study.
A total of 68 eyes of 54 patients suffering from medically uncontrolled pseudoexfoliation glaucoma were treated by bimanual trabecular aspiration. Thirty-four eyes of 28 pseudoexfoliative patients treated by standard trabeculectomy constituted the control group.
Trabecular debris and pigment were cleared with a suction force of 100 to 200 mmHg under light tissue-instrument contact using a modified intraocular aspiration probe. The aspiration cannula is 400 microm in diameter and horizontally angulated at 45 degrees. Irrigation of the anterior chamber was performed via a separate irrigation cannula.
The IOP and number of medications before and after surgery were measured.
In 42 eyes of 36 patients, trabecular aspiration was performed in combination with cataract extraction and lens implantation. The IOP dropped from 32.4 +/- 7.2 mmHg (range, 23-52 mmHg) under maximal tolerated medical therapy before surgery to 18.7 +/- 1.7 mmHg (range, 16-23 mmHg) at 2 years after surgery, with 54% of patients being controlled without medication. In 22 eyes of 19 patients, trabecular aspiration was performed as primary surgical intervention. The IOP dropped from 31.3 +/- 7.1 mmHg (range, 23-42 mmHg) before surgery to 16.8 +/- 3.4 mmHg (range, 12-23 mmHg) at 18 months after surgery, with 45% of patients not taking medication.
Bimanual trabecular aspiration is safe and efficacious in decreasing IOP both with and without cataract extraction in pseudoexfoliation glaucoma. However, there seems to be a slight regression in effect over time attributed to undisturbed liberation of exfoliative debris. Argon-laser trabeculoplasty before trabecular aspiration reduces the IOP-lowering effect of this procedure. A prospective, randomized, multicenter study is warranted to finally assess the potential of trabecular aspiration in pseudoexfoliation glaucoma.
假性剥脱性青光眼眼压升高的主要原因是小梁间隙被剥脱物质阻塞。此前，作者报道了一种非滤过性青光眼手术——小梁抽吸术的新概念，旨在增加假性剥脱性青光眼的小梁房水流出量。在本研究中，将对改良器械、改进的手术技术及长期临床结果进行描述，以证实小梁抽吸术在假性剥脱性青光眼手术治疗中的疗效。
本研究设计为前瞻性非随机研究。
54例药物治疗无法控制的假性剥脱性青光眼患者共68只眼接受了双手小梁抽吸术治疗。28例假性剥脱性患者的34只眼接受标准小梁切除术作为对照组。
使用改良的眼内抽吸探针，在轻柔的组织器械接触下，以100至200mmHg的吸力清除小梁碎屑和色素。抽吸套管直径为400微米，水平成角45度。通过单独的冲洗套管进行前房冲洗。
测量手术前后的眼压及用药数量。
36例患者的42只眼中，小梁抽吸术与白内障摘除及晶状体植入联合进行。眼压从术前最大耐受药物治疗下的32.4±7.2mmHg（范围23 - 52mmHg）降至术后2年的18.7±1.7mmHg（范围16 - 23mmHg），54%的患者无需药物治疗眼压得到控制。19例患者的22只眼中，小梁抽吸术作为主要手术干预措施。眼压从术前的31.3±7.1mmHg（范围23 - 42mmHg）降至术后18个月的16.8±3.4mmHg（范围12 - 23mmHg），45%的患者无需用药。
双手小梁抽吸术在假性剥脱性青光眼患者中，无论是否联合白内障摘除术，在降低眼压方面都是安全有效的。然而，随着时间推移，由于剥脱碎屑的持续释放，效果似乎略有减退。小梁抽吸术前进行氩激光小梁成形术会降低该手术的降眼压效果。有必要进行一项前瞻性、随机、多中心研究，以最终评估小梁抽吸术在假性剥脱性青光眼治疗中的潜力。
