Wirksamkeit der selektiven Lasertrabekuloplastik bei Patienten mit unzureichender Augendrucksenkung unter maximaler Therapie

Abstract

Background: Reduction of intraocular pressure (IOP) is still the primary goal of glaucoma treatment. The aim of this prospective study was to examine the IOP lowering effect of selective laser trabeculoplasty (SLT) in patients on maximum tolerated medical therapy (MTMT), especially with regard to a potential influence of pseudophakia and topical prostaglandin analogues (PGA) on IOP reduction. Material and methods: A total of 30 patients with a diagnosis of primary open angle glaucoma, normal tension glaucoma and pseudoexfoliative glaucoma with uncontrolled IOP despite MTMT underwent SLT treatment circumferentially over 360°. Follow-up visits were conducted 1 day after SLT and then 1, 3, 6, 9, and 12 months post-treatment. The initial medication was continued unchanged for 3 months. Results: Median follow-up was 11. 97 ± 3. 1 months, mean IOP at baseline was 19. 60 ± 4. 69 mmHg, mean IOP reduction was -19. 95 ± 17. 14% 1 month after and -14. 07 ± 23. 57% 12 months after SLT (p < 0. 001 and p = 0. 003, respectively). Patients with higher baseline IOP had greater reduction of IOP after SLT (R2 = 0. 482, p < 0. 001). Phakic patients had a significantly greater IOP reduction compared to pseudophakic patients (- 4. 55 ± 4. 45 mmHg and + 2. 75 ± 6. 75 mmHg, respectively, p = 0. 010). Patients without PGA had a statistically insignificant greater IOP reduction compared to patients with PGA (- 7. 40 ± 4. 72 mmHg and -2. 48 ± 5. 22 mmHg, respectively, p = 0. 066) and four patients needed additional surgery to lower IOP. Conclusion: Even in patients already on maximum IOP lowering medication, SLT has the potential to significantly reduce IOP up to 1 year after treatment. The IOP reduction is most pronounced in phakic eyes with high preoperative IOP. © 2012 Springer-Verlag.