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ABSTRACT
Combined trepanotrabeculectomy (TTE) and intracapsular cataract extraction for advanced cataract and severe open angle glaucoma proved to be successful in 84% of the operated eyes which were followed for one to 11 years. Complications were infrequent as compared to other combined procedures. The frequency of postoperative flat anterior chamber in particular was much lower. In 77% of the eyes the surgical scars were covered by normal conjunctiva without evidence of extraocular filtration. No avascular cystic blebs formed. The same operation performed as a secondary procedure seems to be equally successful. Eight eyes, which previously had successful trepanotrabeculectomy, developed cataract, which was removed without impinging on the function of the trabeculectomy scars. If the two operations are to be performed in separate sittings, it is advisable to perform the TTE first, followed by cataract extraction.
The ophthalmic surgeon faces a dilemma when confronted by a patient with uncontrolled open angle glaucoma associated with advanced cataract. If he chooses to normalize the intraocular pressure (IOP) first by performing a classic filtering procedure or cyclodialysis, the cataract will advance rapidly. The following cataract extraction will jeopardize the glaucoma operation in about 50% of the cases.1 If he chooses to perform the cataract operation first, the intraocular pressure may be easier to control, but only for a limited time, usually 12 to 18 months.'-3 The classic filtering operations and cyclodialysis after cataract surgery are often unsuccessful. Ideally, a combined cataract and glaucoma operation in one sitting is desirable. A variety of such combined operations have been advocated, mainly filtering-cataract operations or cyclodialysis-cataract2,4,5 but they were not accepted because of ineffectiveness or the frequency of complications.1,6
Since Cairns' work in 1968,7,8 microsurgical trabeculectomy has become popular, largely replacing the classic filtering operations. In 1969, I developed trepanotrabeculectomy (TTE) based on experiments on Eye Bank eyes.9 The combined TTE and cataract operation was described in 19709 and 1971 l0 with encouraging results. I reported on a larger number of cases in 1974" with longer follow-up. Similar combined techniques were subsequently reported with good results.12,5
I have used the original technique of trepanotrabeculectomy combined with cataract extraction ,0M and followed many of the eyes over the last 14 years , a period sufficient to arrive at definitive observations regarding...