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Catalogue excerpts

ORIGINAL PAPER Washout of pseudoexfoliation material combined with cataract surgery: a new surgical approach to lower intraocular pressure in pseudoexfoliation syndrome V. Tao Tran Received: 1 December 2013 / Accepted: 16 March 2014 / Published online: 5 April 2014 Ó The Author(s) 2014. This article is published with open access at Springerlink.com Abstract Glaucoma or ocular hypertension can be caused by the presence of pseudoexfoliation (PEX) material and/or pigmented cells in the trabecular meshwork (TM) and/or in the irido-corneal angle (ICA). Accumulation of this material can be highlighted by slit-lamp (SL), gonioscopy, and ultrasound biomicroscopy (UBM). Such material prevents aqueous humor from flowing out and thus induces intraocular pressure (IOP) elevation. A new technique using a special cannula for washing the TM and ICA, combined with cataract surgery, can lower IOP and reduce the number of hypotensive drugs needed. This study analyzed 11 patients (13 eyes) presenting a pseudoexfoliation glaucoma with cataract. They all had cataract surgery combined with the special washing technique. Visual acuity and IOP were noted before surgery, just after surgery and during followup. The number of hypotensive drugs needed was also recorded. Mean follow-up time was 34.4 months (range 21.8–59.2). The first case underwent surgery in 2007 and has a 5-year follow-up time. Local status was controlled by SL, gonioscopy, and UBM. Mean This presentation was awarded the third prize for the new innovative surgery technique at the congress of ESCRS in September 2012 in Milan. age was 79 years (range 71.6–86.0). Mean visual acuity was 0.37 pre-op (range 0.05–0.6) and 0.89 postop (range 0.05–1.0). Mean IOP before and after surgery was 32.8 ± 8.7 mmHg (range 20–53) and 15.1 ± 3.5 mmHg (range 10–20), respectively. The amount of hypotensive drugs needed was 87 % lower after surgery. No PEX material recurrence was seen with SL, gonioscopy, and UBM during the mean follow-up of 3 years. No complication was recorded in this study. Cataract surgery combined with the new washout technique of the TM and ICA to remove PEX material or pigmented cells significantly lowers IOP and the amount of drugs needed. Long-term follow-up gives good results with no complication or recurrence. Eye status after surgery remains physiological and further glaucoma surgery can be performed if necessary. More research with a higher number of patients should be initiated to confirm this technique. Keywords Glaucoma Á Pseudoexfoliation Á Pseudoexfoliation syndrome (XFS) Á Pseudoexfoliation glaucoma (XFG) Á Cataract surgery Á New washing technique Á Special cannula Introduction V. T. Tran (&) Centre for Ophthalmic Specialised Care, Clinic Montchoisi, Av. Beaumont 9, 1012 Lausanne, Switzerland e-mail: trancanula@citycable.ch Dr. John G. Lindberg used the term ‘‘exfoliation’’ for the first time in 1917 [1]. Pseudoexfoliation syndrome (XFS) is a syst

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progressive formation and accumulation of fibrillar deposits in various tissues and organs [2, 3]. Ocular involvement in this syndrome is manifested by the chronic accumulation of an abnormal fibrillar matrix product or a complex of glycoproteins/proteoglycans [4] on the ciliary body, the zonules [5], the anterior surface of the lens [6], the iris, the edge of the pupil, the corneal endothelium, in the irido-corneal angle (ICA), on the trabecular meshwork (TM), and in Schlemm’s canal [7]. Although the physiopathology of this phenomenon is unclear, this anatomical distribution would support the hypothesis...

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Fig. 1 Cannula with two jets Fig. 2 Cannula with only one jet after fusion op to prevent ocular hypertension (postoperative IOP spike) after washout. Potentially, the complications of this new method include transient increase of IOP on the first post-op day, deformation of the pupil, thinning/atrophy or perforation of the iris and irido-dialysis due to the force of the water jet, the presence of hemorrhage from microvessels of the ICA and a cloud of pigment in the anterior or posterior chamber per-operatively, marking, peeling or tearing of the corneal endothelium due to direct contact with the...

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Fig. 5 Follow-up of visual acuity (D day, M month, Y year) Snellen visual acuity Fig. 6 Follow-up of intraocular pressure (D day, M month, Y year) Once merged into one water jet, we can now wash the TM and the ICA to remove the PEX material and pigment accumulation as much as possible. Due to a greater accumulation of material in the lower quadrants, the washout time for the lower area is usually longer, lasting about two minutes in the 3 and 9 o’clock segments, and being about one minute for the upper area. The cannula should be placed directly but not close to the ICA to ensure optimal flow and...

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measurement, visual field testing, and recording of glaucoma treatments before surgery, after surgery, and during follow-up. Best-corrected visual acuity was recorded using Snellen chart, IOP measurement was performed using Goldmann applanation tonometry. Slit-lamp and gonioscopy were performed in all patients. UBM was performed before and after surgery in the cases of presence of PEX material especially in the ICA and/or on the TM. The number of ocular hypotensive drugs needed was recorded before and after surgery. Demographic elements such as age and gender as well as ocular case history were...

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214 ¨ 4. Ritch R, Schlotzer-Schrehardt U (2001) Exfoliation syndrome. Surv Ophthalmol 45(4):265–315 (Review) 5. Ritch R, Vessani RM, Tran HV, Ishikawa H, Tello C, Liebmann JM (2007) Ultrasound biomicroscopic assessment of zonular appearance in exfoliation syndrome. Acta Ophthalmol Scand 85(5):495–499 Epub 2007 Jun 21 ¨ ¨ ¨ 6. Tetsumoto K, Schlotzer-Schrehardt U, Kuchle M, Dorfler S, Naumann GO (1992) Precapsular layer of the anterior lens capsule in early pseudoexfoliation syndrome. Graefes Arch Clin Exp Ophthalmol 230(3):252–257 ¨ 7. Schlotzer-Schrehardt U, Naumann GO (1995) Trabecular meshwork...

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