Effect of trabecular aspiration on intraocular pressure in pigment dispersion syndrome and pigmentary glaucoma

Objective: Recently, we described a new form of nonfiltering glaucoma surge ry--trabecular aspiration-designed to increase trabecular outflow in pseudo exfoliation glaucoma. This study was carried out to investigate whether tra becular aspiration is equally safe and effective in the treatment of pigmen t dispersion syndrome (PDS) and pigmentary glaucoma (PG), Study Design: Prospective, nonrandomized comparative trial with historical control. Participants: Twenty eyes of 20 patients with medically uncontrolled intrao cular pressure (IOP) caused by PDS or PG were treated by trabecular aspirat ion. Intervention: Trabecular pigment particles were cleared with a pressure of 100 to 200 mmHg using a specially designed aspiration probe. Main Outcome Measures: The IOP and number of medications before and after s urgery were measured. Intraoperative and postoperative complications were a nalyzed. Surgical success was defined as IOP less than or equal to 21 mmHg with no more than one topical medication. Results were compared with those previously reported with similar treatment of pseudoexfoliative glaucoma. Results: Mean pretreatment IOP averaged 27.0 (standard deviation [SD], 3.3) mmHg and was significantly reduced to 23.7 (SD, 3.9) mmHg at last follow-u p (20.1 +/- 8.6 months). However, the cumulative life-table success rates w ere only 42% and 15% at 3 and 12 months, respectively, Considering both gro ups separately, the success rates in the PDS group were 63% and 18% at 3 an d 12 months compared with a success rate of 12% in the PG group as early as 1 month after surgery. Conclusions: Eyes with PDS responded better to trabecular aspiration than d o those with PG, indicating that PDS and PG are two successive stages of th e same disease process. Altogether, trabecular aspiration failed to achieve long-term pressure control in either of the two groups. (C) 2000 by the Am erican Academy of Ophthalmology.