Laser-Trabekuloplastik oder Goniotrepanation. Eine prospektive vergleichende Studie

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Abstract
In a consecutive series of glaucoma patients, laser trabeculoplasty was performed in 115 eyes and goniotrephination in 44 eyes. Follow-up time ranged from 3 to 29 months. In the group treated by laser trabeculoplasty, intraocular pressure was reduced by the least 20% and was below 25 mm Hg at the end of the study in 50% of the eyes. On the basis of these criteria, intraocular pressure was controlled in 91% of the eyes in the goniotrephination group. A significant pressure elevation occurred in 9% of the eyes in the trabeculoplasty group, but in none of the eyes in the goniotrephination group. At the end of the study the mean pressure reduction in the laser trabeculoplasty group was 5 mm Hg (19% of the initial value), whereas in the goniotrephination group it was 13.6 mm Hg (46% of the initial value). When tested with the Octopus perimeter, there was no change in the mean sensitivity of the visual fields during the study in the eyes treated by laser trabeculoplasty. In the eyes treated by goniotrephination, the mean sensitivity improved, probably due to a postoperative increase in pupillary diameter. There were two cases of acute cataract formation caused by a flat anterior chamber in the goniotrephination group. The incidence of reduction of visual acuity in the goniotrephination group was 14%, as compared to 6% in the laser trabeculoplasty group. From the results of this study the authors conclude that in cases in which a considerable pressure reduction is called for because of extensive field loss or high intraocular pressure, goniotrephination is to be preferred. In only eyes or eyes with better visual acuity the authors prefer trabeculoplasty because of its low risk. Laser trabeculoplasty can also be performed in eyes with narrow angles after iridectomy to widen the peripheral anterior chamber, thus avoiding the risk of malignant glaucoma in filtering surgery.