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Der Ophthalmologe

, Volume 109, Issue 7, pp 683–690 | Cite as

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

  • C. HirnEmail author
  • S.A. Zweifel
  • M. Töteberg-Harms
  • J. Funk
Originalien

Zusammenfassung

Hintergrund

Hauptziel der Glaukomtherapie ist die Senkung des Intraokulardruckes (IOD). Ziel dieser prospektiven Studie war es, die IOD-senkende Wirkung der selektiven Lasertrabekuloplastik (SLT) bei Patienten unter maximaler medikamentöser Therapie (MMT) zu untersuchen. Spezielles Augenmerk wurde auf eine mögliche Wechselwirkung mit Pseudophakie oder Prostaglandintherapie (PGT) gelegt.

Material und Methoden

Bei 30 Patienten mit primärem Offenwinkelglaukom, Normaldruckglaukom und Pseudoexfoliationsglaukom mit unzureichender IOD-Senkung unter MMT wurde eine SLT über 360° Zirkumferenz durchgeführt. Verlaufskontrollen fanden nach 1 Tag sowie nach 1, 3, 6, 9 und 12 Monaten statt. Die IOD-senkende Therapie wurde über 3 Monate unverändert weitergeführt.

Ergebnisse

Die mittlere Verlaufsbeobachtungszeit betrug 11,97 ± 3,1 Monate. Der mittlere IOD vor SLT war 19,60 ± 4,69 mmHg. Die mittlere IOD-Senkung war −19,95 ± 17,14% nach 1 Monat (p<0,001) sowie −14,07 ± 23,57% nach 12 Monaten (p=0,003). Patienten mit einem höheren präoperativen IOD hatten eine stärker ausgeprägte Drucksenkung (R2=0,482; p<0,001). Phake Patienten hatten eine signifikant ausgeprägtere IOD-Senkung im Vergleich zu pseudophaken Patienten (–4,55±4,45 mmHg bzw. +2,75±6,75 mmHg; p=0,010). Patienten ohne PGT hatten eine statistisch knapp nicht signifikant ausgeprägtere IOD-Senkung im Vergleich zu Patienten mit PGT (–7,40±4,72 mmHg bzw. –2,48±5,22 mmHg; p=0,066). Vier Patienten benötigten einen weiteren IOD-senkenden Eingriff.

Schlussfolgerung

Bei Patienten unter MMT kann durch eine SLT der IOD bis zu 1 Jahr noch signifikant gesenkt werden. Die IOD-senkende Wirkung ist bei phaken Patienten mit hohem Ausgangsdruck am stärksten ausgeprägt.

Schlüsselwörter

Selektive Lasertrabekuloplastik Prostaglandin Pseudophakie Intraokularer Druck Glaukom 

Effectiveness of selective laser trabeculoplasty in patients with insufficient control of intraocular pressure despite maximum tolerated medical therapy

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.

Keywords

Selective laser trabeculoplasty Prostaglandin Pseudophakia Intraocular pressure Glaucoma 

Notes

Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehung hin: Teilweise Reisekostenübernahme durch die Firma Ellex (Ellex Medical Pty Ltd., Adelaide, SA 5000, Australia).

Literatur

  1. 1.
    Almeida EDJ, Pinto LM, Fernandes RA et al (2011) Pattern of intraocular pressure reduction following laser trabeculoplasty in open-angle glaucoma patients: comparison between selective and nonselective treatment. Clin Ophthalmol 5:933–936PubMedGoogle Scholar
  2. 2.
    Alvarado JA, Alvarado RG, Yeh RF et al (2005) A new insight into the cellular regulation of aqueous outflow: How trabecular meshwork endothelial cells drive a mechanism that regulates the permeability of Schlemm’s canal endothelial cells. Br J Ophthalmol 89:1500–1505PubMedCrossRefGoogle Scholar
  3. 3.
    Alvarado JA, Iguchi R, Martinez J et al (2010) Similar effects of selective laser trabeculoplasty and prostaglandin analogs on the permeability of cultured Schlemm canal cells. Am J Ophthalmol 150:254–264PubMedCrossRefGoogle Scholar
  4. 4.
    Alvarado JA, Yeh RF, Franse-Carman L et al (2005) Interactions between endothelia of the trabecular meshwork and of Schlemm’s canal: a new insight into the regulation of aqueous outflow in the eye. Trans Am Ophthalmol Soc 103:148–162, discussion 162–143PubMedGoogle Scholar
  5. 5.
    Anonymous (1995) The Glaucoma Laser Trial (GLT) and glaucoma laser trial follow-up study: 7. Results. Glaucoma Laser Trial Research Group. Am J Ophthalmol 120:718–731Google Scholar
  6. 6.
    Bahler CK, Howell KG, Hann CR et al (2008) Prostaglandins increase trabecular meshwork outflow facility in cultured human anterior segments. Am J Ophthalmol 145:114–119PubMedCrossRefGoogle Scholar
  7. 7.
    Barkana Y, Belkin M (2007) Selective laser trabeculoplasty. Surv Ophthalmol 52:634–654PubMedCrossRefGoogle Scholar
  8. 8.
    Chen E, Golchin S, Blomdahl S (2004) A comparison between 90 degrees and 180 degrees selective laser trabeculoplasty. J Glaucoma 13:62–65PubMedCrossRefGoogle Scholar
  9. 9.
    Damji KF, Bovell AM, Hodge WG et al (2006) Selective laser trabeculoplasty versus argon laser trabeculoplasty: results from a 1-year randomised clinical trial. Br J Ophthalmol 90:1490–1494PubMedCrossRefGoogle Scholar
  10. 10.
    Damji KF, Shah KC, Rock WJ et al (1999) Selective laser trabeculoplasty vs argon laser trabeculoplasty: a prospective randomised clinical trial. Br J Ophthalmol 83:718–722PubMedCrossRefGoogle Scholar
  11. 11.
    George MK, Emerson JW, Cheema SA et al (2008) Evaluation of a modified protocol for selective laser trabeculoplasty. J Glaucoma 17:197–202PubMedCrossRefGoogle Scholar
  12. 12.
    Goyal S, Beltran-Agullo L, Rashid S et al (2010) Effect of primary selective laser trabeculoplasty on tonographic outflow facility: a randomised clinical trial. Br J Ophthalmol 94:1443–1447PubMedCrossRefGoogle Scholar
  13. 13.
    Gracner T (2001) Intraocular pressure response to selective laser trabeculoplasty in the treatment of primary open-angle glaucoma. Ophthalmologica 215:267–270PubMedCrossRefGoogle Scholar
  14. 14.
    Gracner T, Pahor D, Gracner B (2003) Efficacy of selective laser trabeculoplasty in the treatment of primary open-angle glaucoma. Klin Monatsbl Augenheilkd 220:848–852PubMedCrossRefGoogle Scholar
  15. 15.
    Hansen TE, Naeser K, Rask KL (1987) A prospective study of intraocular pressure four months after extracapsular cataract extraction with implantation of posterior chamber lenses. J Cataract Refract Surg 13:35–38PubMedGoogle Scholar
  16. 16.
    Heijl A, Leske MC, Bengtsson B et al (2002) Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol 120:1268–1279PubMedGoogle Scholar
  17. 17.
    Kara N, Altan C, Satana B et al (2011) Comparison of selective laser trabeculoplasty success in patients treated with either prostaglandin or timolol/dorzolamide fixed combination. J Ocul Pharmacol Ther 27:339–342PubMedCrossRefGoogle Scholar
  18. 18.
    Lanzetta P, Menchini U, Virgili G (1999) Immediate intraocular pressure response to selective laser trabeculoplasty. Br J Ophthalmol 83:29–32PubMedCrossRefGoogle Scholar
  19. 19.
    Latina MA, Sibayan SA, Shin DH et al (1998) Q-switched 532-nm Nd:YAG laser trabeculoplasty (selective laser trabeculoplasty): a multicenter, pilot, clinical study. Ophthalmology 105:2082–2088, discussion 2089–2090PubMedCrossRefGoogle Scholar
  20. 20.
    Lim KS, Nau CB, O’Byrne MM et al (2008) Mechanism of action of bimatoprost, latanoprost, and travoprost in healthy subjects. A crossover study. Ophthalmology 115:790–795PubMedCrossRefGoogle Scholar
  21. 21.
    Mahdaviani S, Kitnarong N, Kropf JK et al (2006) Efficacy of laser trabeculoplasty in phakic and pseudophakic patients with primary open-angle glaucoma. Ophthalmic Surg Lasers Imaging 37:394–398PubMedGoogle Scholar
  22. 22.
    Mao AJ, Pan XJ, McIlraith I et al (2008) Development of a prediction rule to estimate the probability of acceptable intraocular pressure reduction after selective laser trabeculoplasty in open-angle glaucoma and ocular hypertension. J Glaucoma 17:449–454PubMedCrossRefGoogle Scholar
  23. 23.
    Martow E, Hutnik CM, Mao A (2011) SLT and adjunctive medical therapy: a prediction rule analysis. J Glaucoma 20:266–270PubMedCrossRefGoogle Scholar
  24. 24.
    Mathalone N, Hyams M, Neiman S et al (2005) Long-term intraocular pressure control after clear corneal phacoemulsification in glaucoma patients. J Cataract Refract Surg 31:479–483PubMedCrossRefGoogle Scholar
  25. 25.
    McIlraith I, Strasfeld M, Colev G et al (2006) Selective laser trabeculoplasty as initial and adjunctive treatment for open-angle glaucoma. J Glaucoma 15:124–130PubMedCrossRefGoogle Scholar
  26. 26.
    Pohjalainen T, Vesti E, Uusitalo RJ et al (2001) Phacoemulsification and intraocular lens implantation in eyes with open-angle glaucoma. Acta Ophthalmol Scand 79:313–316PubMedCrossRefGoogle Scholar
  27. 27.
    Rachmiel R, Trope GE, Chipman ML et al (2006) Laser trabeculoplasty trends with the introduction of new medical treatments and selective laser trabeculoplasty. J Glaucoma 15:306–309PubMedCrossRefGoogle Scholar
  28. 28.
    Realini T (2008) Selective laser trabeculoplasty: a review. J Glaucoma 17:497–502PubMedCrossRefGoogle Scholar
  29. 29.
    Sacca S, Marletta A, Pascotto A et al (2001) Daily tonometric curves after cataract surgery. Br J Ophthalmol 85:24–29PubMedCrossRefGoogle Scholar
  30. 30.
    Scherer WJ (2007) Effect of topical prostaglandin analog use on outcome following selective laser trabeculoplasty. J Ocul Pharmacol Ther 23:503–512PubMedCrossRefGoogle Scholar
  31. 31.
    Shazly TA, Latina MA, Dagianis JJ et al (2011) Effect of prior cataract surgery on the long-term outcome of selective laser trabeculoplasty. Clin Ophthalmol 5:377–380PubMedCrossRefGoogle Scholar
  32. 32.
    Singh D, Coote MA, O’hare F et al (2009) Topical prostaglandin analogues do not affect selective laser trabeculoplasty outcomes. Eye (Lond) 23:2194–2199Google Scholar
  33. 33.
    European Glaucoma Society (2008) Terminologie und Handlungsrichtlinien für die Glaukome. Dogma, SavonaGoogle Scholar
  34. 34.
    Song J, Lee PP, Epstein DL et al (2005) High failure rate associated with 180 degrees selective laser trabeculoplasty. J Glaucoma 14:400–408PubMedCrossRefGoogle Scholar
  35. 35.
    Toris CB, Gabelt BT, Kaufman PL (2008) Update on the mechanism of action of topical prostaglandins for intraocular pressure reduction. Surv Ophthalmol 53(Suppl 1):107–120CrossRefGoogle Scholar
  36. 36.
    Werner M, Smith MF, Doyle JW (2007) Selective laser trabeculoplasty in phakic and pseudophakic eyes. Ophthalmic Surg Lasers Imaging 38:182–188PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • C. Hirn
    • 1
    • 2
    Email author
  • S.A. Zweifel
    • 1
  • M. Töteberg-Harms
    • 1
    • 3
  • J. Funk
    • 1
  1. 1.AugenklinikUniversitätsSpital ZürichZürichSchweiz
  2. 2.NIHR BRC for OphthalmologyMoorfields Eye Hospital NHS Foundation TrustLondonUK
  3. 3.Massachusetts Eye & Ear InfirmaryHarvard Medical SchoolBostonUSA

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