[Indications and contraindications of the combined operation (fistulation and cataract extraction) in open- and closed-angle glaucoma (author's transl)]

Abstract

The respective indications are briefly described for: a) trabeculectomy through a scleral flap, b) simple cataract extraction, c) combined operation of lens extraction and fistulation in open-angle glaucoma on the one hand and close-angle glaucoma on the other. The choice of operation is dictated by many considerations. The main considerations are as follows. A Lens extraction alone has no lasting effect on the pressure in open-angle glaucoma, but is a good operation against early closed-angle glaucoma. B. Any fistulising operation predisposes to cataract when performed on old patients whose lenses suffer from senile changes already before the operation. A fistulising operation predisposes more to cataract in close-angle as in open-angle glaucoma. C. Lens extraction removes the risk of post-operative "athalamia" and hence of post-operative malignant glaucoma. D. The combined operation avoids a second surgical intervention and reduces the risks of oedematous dystrophy of the cornea in elderly patients who already have before the operation definite signs of endothelial dystrophy. E. Combining the glaucoma and cataract operations although, having certain peculiar risks, gives in a high percentages of cases efficient and long-lasting fistulation and a satisfactory intracapsular lens extraction.