Surgical treatment of open-angle glaucoma.

Abstract

The influence of intraocular pressure (IOP) on the visual field of glaucoma patients is discussed; the criterion level for postoperative IOP control was set at 20 mmHg. When the IOP exceeded this level for two consecutive months, the IOP control was judged to be a failure, and the surgical results were analysed by a life-table method. Argon laser trabeculoplasty (ALT) with 50 shots over 180 degrees of the angle was used routinely, because of fewer complications than with 360 degrees ALT. A second session sometimes improved the final success rate, which was about 57% in primary open-angle glaucoma and 94% in capsular glaucoma after a follow-up period of two years and two months. All patients (120 eyes) required drugs, but their use could be reduced in about 35%. The IOP distribution in successful cases showed a peak at 16 to 17 mmHg, and the IOP was 15 mmHg or less in 21%. In trabeculectomy, pretreatment with topical indomethacin and steroid drip infusion was advocated, and concentrated sodium hyaluronate was used during surgery. These procedures reduced the incidence of shallow anterior chamber and associated choroidal detachment. The final success rate was about 60% after five years of follow-up. The IOP distribution after more than two years peaked at 13 to 15 mmHg, and the IOP was 15 mmHg or less in 53%.