Goniocurettage for removing trabecular meshwork: Clinical results of a newsurgical technique in advanced chronic open-angle glaucoma

PURPOSE: To elucidate the long term outcome of goniocurettage as a new tech nique in trabecular microsurgery for advanced open-angle glaucoma, METHODS: In a prospective, nonrandomized clinical trial, 25 eyes of 25 pati ents with a mean age +/- SD of 72.7 +/- 10.1 years (range, 50 to sg years) with uncontrolled chronic open-angle glaucoma that had undergone failed fil tering procedures were treated by goniocurettage. Trabecular tissue was scr aped away from the chamber angle by means of an instrument similar to a mic rochalazion curette (diameter, 300 mu m). RESULTS: Before surgery, intraocular pressure ranged from 29 to 48 mm Hg (m ean +/- SD, 34.7 +/- 7.1 mm Hg), and mean number of antiglaucoma medication s was 2.2 +/- 0.56. Follow-up averaged (+/-SD) 32.6 +/- 8.1 months (range, 30 to 45 months), Overall success, defined as postoperative intraocular pre ssure of 19 mm Hg or less with one pressure-reducing agent, was attained in 15 eyes (60%), with five eyes (20%) being controlled without medication. C onsidering all successfully treated patients, the mean intraocular pressure was 17.7 +/- 3.1 mm Hg (range, 10 to 19 mm Hg) at the final visit. Mean in traocular pressure reduction was 17.1 +/- 7.1 mm Hg in these eyes, represen ting a net decrease from baseline of 49%. Number of antiglaucoma medication s dropped to 0.63 +/- 0.29. Complications included localized Descemet membr ane detachment in five eyes (20%) and moderate anterior chamber bleeding in four eyes (16%), CONCLUSIONS: This new surgical technique can effectively control intraocula r pressure for long periods of time in patients with open angle glaucoma an d a history of failed filtering procedures. Goniocurettage may be a suitabl e alternative to surgical treatment of glaucoma patients with excessive con junctival scarification. (C) 1999 by Elsevier Science Inc, All rights reser ved.