What is goniotomy
The gold standard in surgical glaucoma therapy are the covered fistulating surgical procedures, i. H. the Cairns trabeculectomy and the Fronimopoulos goniotrepanation.
- University Eye Clinic Dresden
Trabeculotomy, (visco) canaloplasty
Deep sclerectomy and viscocanalostomy
Deep sclerectomy in combination with viscocanalostomy has recently been suggested as an alternative to trabeculectomy. The aim of the operation is to uncover Schlemm's canal, expose Descemet and create an aqueous reservoir under a scleral cover that connects to the aqueous humor. By filling in a viscoelastic, Schlemm's canal and the trabecular network are to be stretched or opened. A "collagen implant" is placed in the aqueous humor reservoir as a placeholder. This alone costs as much as two intraocular lenses. Long-term results are still pending. So far there is only one peer-reviewed, published study (Brit J Ophthalmol 83: 6, 1999). The success rate is 80-90% and is thus at the level of trabeculectomy. The same applies to the complication rate: As with trabeculectomy, hyphema and choroidal damage can occur. Intraoperatively, the viscocanalostomy can result in descemetolysis. However, the most common form of perforation. If this goes unnoticed, the chamber angle synchro- nisms develop. If the perforation is noticed, the procedure can be converted into a submerged fistulating operation, but with the risk of hypotension. Further measures such as needling (34%), the administration of 5FU (30%) and an Nd / YAG goniotomy (41%) were necessary for the patients in the study. All forms of open-angle glaucoma are given as an indication. Two randomized studies are currently running in Germany (Cologne, Brandenburg).
Selective laser trabeculoplasty (SLT)
The goniotomy has the same effect as the trabeculotomy, namely the tearing of the membrane in front of the trabecular meshwork. However, it is entered with a small lance through the cornea at the edge into the anterior chamber and the membrane is removed in the opposite chamber corner. The trabecular meshwork is made visible through a mirror (gonioscope) that is placed on the cornea during the operation.
A laser removes the trabecular structure and opens Schlemm's canal from the inside. The most common complication we've seen is hyphema from backflow of blood from Schlemm's canal. Usually it is absorbed after a few days. As with the other procedures, there are no long-term results here either. The data available so far speak for a successful pressure reduction in approx. 75% of the patients.
- At the tip of the trabectome there is a tiny electric knife as well as a suction and an infusion channel. With the trabectome, the ophthalmologists remove the so-called “trabecular meshwork” in the eye through an incision in the cornea that is only 1.6 millimeters wide. A hardening of this plexus is often the reason why the aqueous humor does not flow away unhindered and the intraocular pressure rises. The minimally invasive procedure is performed under local anesthesia and only takes about ten minutes. (IOP reduction of up to 40 percent). The amount of hypotensive eye drops can be reduced significantly.
- (Abstract )
The glaucoma (glaucoma) is based on too high intraocular pressure. With certain forms of glaucoma, a pressure-lowering operation can be performed using a special diode laser. With the diode laser, the radiation body (ciliary body) of the eye is partially obliterated and the production of aqueous humor in the eye is reduced (cyclophotocoagulation). When less aqueous humor is produced, the intraocular pressure drops. Cyclophotocoagulation has been carried out in the eye department of the North Hospital for 6 years. Cyclophotocoagulation is a very gentle and painless treatment method and replaces the previous cold treatment of the radiation body (cyclocryocoagulation).
In order to achieve the desired effect, however, the cyclophotocoagulation must be repeated in some patients. A gradual lowering of the intraocular pressure through repeated cyclophotocoagulations is better than an excessive pressure drop through a single, too intensive treatment.
Cyclophotocoagulation can be performed on an outpatient basis. However, because of the close monitoring of intraocular pressure required before and after cyclophotocoagulation, inpatient treatment is usually preferable
With endocyclophotocoagulation, the ciliary body processes are coagulated under endoscopic view. Access is either via a corneal incision or via the pars plana. The targeted coagulation allows a "titration" of the effects and the avoidance of collateral damage. Complications such as fibrin reaction, macular edema and choroidal amotio occur just as frequently as with transscleral cyclophotocoagulation. Endocyclophotocoagulation is recommended for simultaneous interventions in the posterior segment with secondary glaucoma, in combination with cataract surgery and for severe glaucoma that cannot be treated otherwise.
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