Trabecular aspiration. A new mode to treat pseudoexfoliation glaucoma

The primary cause of intraocular pressure (IOP) elevation in pseudoexfoliation glaucoma is obstruction of the intertrabecular spaces by exfoliation material. The aim of the current study was to evaluate the efficacy of a novel surgical approach--trabecular aspiration--for the management of pseudoexfoliation glaucoma.

Twelve patients characterized by medically uncontrolled IOP level in pseudoexfoliation glaucoma underwent trabecular aspiration as a primary antiglaucomatous procedure. Aspiration treatment of the meshwork was performed in the inferior circumference of the chamber angle using a specially designed irrigation-aspiration device to fit the chamber angle. Trabecular debris and pigment were cleared with a suction force of 100 to 200 mm Hg.

Before surgery, IOP ranged from 24 mm Hg to 52 mm Hg (mean, 37.4 mm Hg). Fifteen months after surgery, IOP ranged from 15 mm Hg to 23 mm Hg (mean, 18.3 mm Hg), which is equivalent to an absolute decrease of 18.7 mm Hg (50%). After surgery, the IOP of 10 eyes was less than 21 mm Hg, although 6 of these eyes still required topical medication. Two eyes attained a final IOP of 24 mm Hg. All treated eyes were aspirated once. Mean antiglaucomatous medication decreased from 4.3 medications daily before surgery to 1.39 medications daily at 15 months after surgery.

This new surgical modality, removing intertrabecular and pretrabecular debris of the trabecular meshwork, can be effective in the management of pseudoexfoliation glaucoma. However, long-term follow-up and extended sample size must be prospected for further clinical evaluation.