The medium and long-term efficacy of primary argon laser trabeculoplasty in avoiding topical medication in open angle glaucoma.

PURPOSE: To study the medium and long-term efficacy of primary argon laser trabeculoplasty in open angle glaucoma with especial emphasis on avoidance of additional medical therapy. METHODS: Records of 168 patients with chronic open angle glaucoma or pseudoexfoliation glaucoma who underwent primary argon laser trabeculoplasty between 1987 and 1995 were studied retrospectively (duration of follow-up 1-8 years, mean 4.1 years). Mean baseline intraocular pressure was 28.7 mmHg (range 22-60 mmHg). Need of additional medical therapy was in each case evaluated at the surgeons' discretion, and the results were analysed by survival analysis. RESULTS: The probability of treatment success (no medication required) was for chronic open angle glaucoma 77% after 2 years, 67% after 5 years and 67% after 8 years Corresponding numbers for pseudoexfoliation glaucoma were 80%, 54% and 36%. Prelaser IOP higher than 31 mmHg, pretreatment visual field defect and sparse pigmentation of the trabecular meshwork were independent predictors of failure. CONCLUSION: Primary argon laser trabeculoplasty gives a long-lasting and favourable effect in chronic open angle glaucoma where 2/3 of the eyes still managed without additional medication for 8 years. The success in pseudoexfoliation glaucoma was even higher the first 3 years, and kept above 50% for 5 years. This makes laser a valuable option as first choice of therapy in glaucoma.     

抗VEGF抗体贝伐单抗在青光眼滤过性手术的应用

新生血管化发生于青光眼滤过性手术的伤口愈合阶段,是对青光眼治疗的挑战.为提高手术成功率,近年来抗VEGF抗体贝伐单抗(bevacizumab,BVZ)应用于青光眼滤过性手术,如原发性开角型青光眼、色素性青光眼、剥脱性青光眼、慢性闭角型青光眼、新生血管性青光眼以及抗青光眼手术失败的再次青光眼滤过性手术.给药方式包括局部给药、结膜下注射、前房内注射、玻璃体内注射、联合给药等.     

Argon laser trabeculoplasty in glaucoma with a narrow chamber angle

In 49 eyes (33 patients) with open-angle glaucoma and narrow angle, which did not respond to conservative therapy, argon laser trabeculoplasty (ALT) was performed after preparative gonioplasty. The success rate was 65.3%. A postoperative rise in IOP was observed in 44.3%, and aqueous humor flare in 63.3%. Goniodysgenesis proved to be prognostically unfavorable for ALT.     

Argon laser trabeculoplasty for open angle glaucoma--a four year follow-up

79 patients (105 eyes) with uncontrolled open angle glaucoma underwent argon laser trabeculoplasty (ALT). The average pressure drop was 10.7 mmHg in 58 eyes at one year, 10.1 mmHg in 35 eyes at two years, 9.9 mm Hg in 48 eyes at three years and 10.2 mmHg in 24 eyes at four years. Teh mean success rate was 78%, failures occurred in the first six months in 21 of 23 eyes, the remaining eyes failed at three years, 18 eyes (17%) required filtering surgery. Average medication scores varied little from year 1 through year 4, 45 eyes (42.9%) were being treated with few medications after ALT. The results of ALT depend on the severity of glaucoma: the eyes with advanced disc damage (C/D greater than 0.9, visual field less than 20 degrees) had 59% rate of filtering surgery, while the eyes with C/D 0.6-0.8, visual field greater than 20 degrees at ALT had a filtering surgery rate of 3%.     

Long-term follow-up of laser trabeculoplasty

In a retrospective study 274 eyes of 207 patients with glaucoma were followed, after they had undergone laser trabeculoplasty (LTP). We evaluated the success of the laser treatment and followed the course of the intraocular pressure (IOP) during 5 1/2 years after treatment. Three diagnosis-groups were formed. Group I consisted of primary open angle glaucoma (n = 208), secondary glaucoma (n = 8) and pigmentary glaucoma (n = 3). Group II (n = 29) consisted of low tension glaucoma. Group III (n = 26) had the diagnosis narrow angle glaucoma. Success was defined as follows: a reduction in IOP, no progressive visual field loss, no visual acuity loss due to glaucoma, no filtering surgery and no repeat LTP. Follow-up was continued until the moment of failure. In the case of success the minimum follow-up was 6 months. The mean decrease in IOP after LTP stabilized in all three groups. During a follow-up of 5 1/2 years the IOP lowering effect did not diminish in successful eyes. To compute the rate of success we used the Kaplan-Meier method. The low tension glaucoma group had a success rate of 82% after 4 years. The probability of success in group I was 53% after 5 1/2 years and in group III 51% after 4 1/2 years. These success rates did not differ significantly. Resuming, this study shows that LTP has postponed the need for surgical intervention at least up to 5 1/2 years.     

Options in pediatric glaucoma after angle surgery has failed

PURPOSE OF REVIEW: Congenital glaucoma is primarily a surgical disease with medical management serving as a temporizing measure before surgery or as postoperative adjunctive treatment. First-line surgery for congenital glaucoma consists of incisional procedures on the anterior chamber angle: goniotomy and trabeculotomy. Angle surgery has a high success rate with few complications. Despite the high initial success rate, almost 20% of angle procedures eventually fail, and surgeons are confronted with a choice of what procedure to do next: a trabeculectomy with or without adjunctive antifibrosis therapy, glaucoma drainage surgery, or cyclodestructive procedures. This review will discuss and compare these procedures as reported in recent studies and how variables such as age, number of prior procedures, and type of glaucoma have clarified the order in which these procedures might be performed after failed angle surgery. RECENT FINDINGS: Clinical reports in refractory pediatric glaucoma consist solely of retrospective studies of varying size and quality. Recent studies of trabeculectomy in this population suggest mitomycin C is associated with increased risk of late infectious complications. Trabeculectomy has worse outcome among younger patients Glaucoma drainage devices have a success rate approaching 80% at 1 year, but less with longer follow-up. Cyclodestructive procedures are generally reserved for advanced cases, but low-dose cyclodiode therapy and endocyclophotocoagulation may prove useful earlier in the disease (< 2 years). SUMMARY: Refractory pediatric glaucoma remains a challenge. Glaucoma drainage devices appear to be the most predictable and possibly safest procedure to consider after failed conventional angle surgery.     

Post-traumatic angle recession glaucoma: a risk factor for bleb failure after trabeculectomy.

In order to determine if post-traumatic angle recession is a risk factor for failure of glaucoma filtering surgery independent of age or race, the surgical results of trabeculectomy performed in 35 consecutive patients with angle recession glaucoma were compared with those of 35 matched patients with primary open angle glaucoma. A postoperative intraocular pressure of < or = 21 mm Hg (with or without glaucoma medication) was found in 15 of the 35 (43%) patients with angle recession glaucoma compared with 26 of the 35 (74%) patients with primary open angle glaucoma. The long term success of trabeculectomy was significantly worse in angle recession glaucoma when the results were analysed using Kaplan-Meier survival curves. Bleb failure occurred a mean period of 3.1 (SD 1.2) months after trabeculectomy in angle recession glaucoma compared with 9.4 (5) months in primary open angle glaucoma (p < or = 0.001). The finding that posttraumatic angle recession is a risk factor for failure of trabeculectomy, supports the use of antimetabolite therapy to suppress fibrosis after trabeculectomy in these patients.     

Argon laser trabeculoplasty in triamcinolone acetonide induced ocular hypertension refractory to maximal medical treatment

PURPOSE: To report two cases of intraocular hypertension after intravitreal injection of triamcinolone acetonide (iTAA) that were refractory to maximal medical therapy and were successfully treated with argon laser trabeculoplasty (ALT). METHODS: Two patients with history of primary open angle glaucoma were treated with intravitreal injection of triamcinolone acetonide for chronic macular edema secondary to branch retinal vein occlusion. Both patients (Case 1 after 2 months and Case 2 after 5 days) developed intraocular hypertension that did not respond to maximal medical therapy. Despite medical therapy, intraocular pressure (IOP) was 45 mmHg in Case 1 and between 34 and 37 mmHg in Case 2. ALT was performed in the inferior 180 degrees angle using the following parameters: 50 microm size, 700 mW, 0.50 sec, 100 spots. RESULTS: In both patients IOP returned to normal level a few days after ALT. CONCLUSIONS: ALT seems to be effective at reducing IOP in patients with intraocular hypertension secondary to iTAA that does not respond to maximal medical treatment.     

Selective laser trabeculoplasty

The introduction of selective laser trabeculoplasty (SLT) provided a new choice for the reduction of intraocular pressure (IOP) in eyes with open angle glaucoma (OAG) and ocular hypertension (OHT). SLT was demonstrated equally as effective as topical medical therapy and argon laser trabeculoplasty (ALT) to lower IOP. It is a potentially repeatable procedure because of the lack of coagulation damage to the trabecular meshwork (TM) and also effect in patients with previously failed ALT. SLT can be used to treat patients with OAG, pseudoexfoliation glaucoma, pigmentary glaucoma, normal-tension glaucoma, OHT, juvenile glaucoma, pseudophakic and aphakic glaucoma. Furthermore, SLT can be considered as a primary treatment option in patients who cannot tolerate or are noncompliant with medications, while not interfering with the success of future surgery. Its safety profiles include mild and transient inflammation, ocular pain and a small risk of moderate IOP elevations after the procedure. SLT is a safe and effective means of IOP reduction in eyes with OAG and OHT.     

Long-term results following argon laser trabeculoplasty

Long-term follow-up findings after argon laser trabeculoplasty are communicated. The coagulation technique employed was that described by Wise and Witter (1979). The circumference of the chamber angle was coagulated over 360 degrees. The indications were chronic open-angle glaucoma, pseudoexfoliation glaucoma, pigmentdispersion glaucoma, glaucoma in aphakia, and glaucoma after ALT or fistulizing surgery with uncontrolled IOP. Glaucoma cases in which IOP exceeded 35 mm Hg were not treated by this method. Therapy was considered successful if a decrease in IOP to below 20 mm Hg was achieved. The difficulties of finding appropriate parameters for the success of glaucoma therapy are discussed. The percentages of normotonic eyes after ALT with a follow-up period of one to four years are reported and compared with results obtained by other authors. After one year, IOP was normal in 89.9% of 881 eyes (chronic open-angle glaucoma 94%, pigment-dispersion glaucoma 91%, pseudoexfoliation glaucoma 86%, glaucoma in aphakia 88%). After two years, it was normal in 72.6% of 237 eyes (chronic open-angle glaucoma 82%, pigment-dispersion glaucoma 50%, pseudoexfoliation glaucoma 53%, glaucoma in aphakia 75%). After three years, it was normal in 60.5% of 76 eyes (chronic open-angle glaucoma 72%, pigment-dispersion glaucoma 25%, pseudoexfoliation glaucoma 37%, glaucoma in aphakia 66%). After four years, it was normal in 95.4% of 128 eyes (chronic open-angle glaucoma 82%, pseudoexfoliation glaucoma 50%). The results of ALT therapy reported by other authors are similar. A decrease in efficiency, initially of 5% to 10% per year, is seen in eyes thus treated, which may necessitate fistulizing surgery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Use of YAG-Selecta laser and argon laser in the treatment of open angle glaucoma

INTRODUCTION: The falling success rate of ALT (Argon Laser Trabeculoplasty) has raised the interest in some new laser techniques, such as q-switched Nd:YAG laser trabeculoplasty (Coherent Selecta 7000). The "selective" laser trabeculoplasty destroys melanosomes of pigmented trabecular meshwork cells, sparing adjacent non-pigmented cells and tissues. AIM: Our goal was to establish the IOP lowering effect of selective laser trabeculoplasty (SLT--Selecta Laser Trabeculoplasty) in comparison with ALT. MATERIAL AND METHODS: We have examined 27 patients (10 men, 17 women) aged 35-82, with open angle glaucoma and visual field deterioration despite maximal tolerated topical therapy (21 patients--POAG, 3--NPG, 1--pigmentary glaucoma, 1--pseudoexfoliative glaucoma, 1--juvenile glaucoma). One eye of each patient was randomly chosen for SLT, the other eye underwent ALT. In each method 50 burns were applied in 180 degrees angle with power settings of 600-1000 mW for ALT and energy settings of 0.5-1.4 mJ for SLT. The IOP was measured 1 hour before laser treatment and 1, 2, 24 hours and 3 months after treatment. RESULTS: The mean initial IOP in eyes selected for SLT was significantly higher (21.26 +/- 4.82 mm Hg) than in eyes selected for ALT (20.26 +/- 4.01 mm Hg), t-test: p = 0.037. However, there was no statistically significant difference in the IOP lowering effect between eyes treated with SLT and eyes treated with ALT. The mean IOP drop from the pre-treatment values was -2.85 +/- 4.62 mm Hg after SLT and -2.63 +/- 3.60 mm Hg after ALT (t-test, p = 0.84). All values: 2, 24-hours and 3 months after treatment were significantly lower than pre-treatment values in both groups (t-test, p < 0.03). Only in the 1st hour after SLT the IOP drop was not significant. There was a significant correlation between the amount of pigment on the trabecular meshwork and the IOP fall (U Mann-Whitney test). In SLT group 6 patients (21%) developed mild iritis during 1st day after laser treatment, which disappeared after fluorometholon drop therapy. CONCLUSION: Both methods--SLT and ALT--have equivalent IOP lowering effect in short time observation (3 months). Due to entirely novel mode of Selecta laser action, long term results may show significant differences.     

Glaucoma filtering surgery,a retrospective study of 300 operations

The results of 300 consecutive glaucoma filtering procedures, which were performed in our clinic between Januari 1982 and September 1985, are described. The overall combined success rate (complete + qualified) was 66.5 % (Heuer's classification). This is in good agreement with other glaucoma referral centers.The peak of the age distribution curve at the time of operation was between 70 and 75 years. Nevertheless, 30 % of operations was performed on patients under 50 years of age.Relatively poor success rates were obtained in operations following prior unsuccessful filtering surgery (50.5 %) or other surgery (47 %), in patients under 50 years of age (61 %) and in some types of secondary glaucoma.In aphakia/pseudophakia the success rate was 33%. The posterior capsule was intact only 13 % of this category at the time of surgery, in 56 % previously unsuccessful filtering surgery had been performed, and the age at operation was relatively young (53 yr). These factors have an unfavorable influence on the results of filtering surgery.The success rate in phakic primary open angle glaucoma was 85 % and in phakic primary angle closure glaucoma 73%.The combination with a cataract extraction (in 28 %) and a peripheral iridectomy, if this had not been performed previously, (in 31 %) may have contributed to the relatively favorable surgical results in phakic primary angle closure glaucoma.Relatively high intraocular pressures were found in the early postoperative period; the peak of the pressure-curve was between 20 and 25mm Hg, 10mm Hg higher than at the end of follow-up. Postoperative progression of glaucomatous visual field defects was noted in 7 %.The most disturbing complication was flat anterior chamber, causing or enhancing cataract formation (in 4 out of 8 phakic patients) and corneal dystrophy (in 2 out of 12 patients). A review of literature is given concerning methods of improving filtration, when the surgical prognosis is poor.     

Long-term clinical results of selective laser trabeculoplasty in the treatment of primary open angle glaucoma

PURPOSE: To investigate the long-term efficacy of selective laser trabeculoplasty (SLT) in primary open-angle glaucoma, the authors performed a non-randomized, prospective, non-comparative clinical case series. METHODS: Fifty-two eyes of 52 patients (19 male, 33 female) with primary open angle glaucoma were treated with SLT. Patients were treated with the Coherent Selecta 7000 (Coherent, Palo Alto, CA, USA) frequency-doubled q-switched Nd:YAG laser (532 nm). A total of approximately 50 non-overlapping spots were placed over 180 degrees of the trabecular meshwork at energy levels ranging from 0.6 to 1.4 mJ per pulse. After surgery, patients were maintained with the drug regimen identical to that before treatment. RESULTS: After 1 year the average reduction in intraocular pressure (IOP) from the baseline was 24.3% (6.0 mmHg), after 2 years 27.8% (6.12 mmHg), after 3 years 24.5% (5.53 mmHg), and after 4 years 29.3% (6.33 mmHg). A Kaplan-Meier survival analysis revealed a 1-year success rate of 60%, a 2-year success rate of 53%, a 3-year success rate of 44%, and a 4-year success rate of 44%. CONCLUSIONS: Despite a declining success rate, SLT is an effective method to lower IOP over an extended period of time.     

Role of argon laser trabeculoplasty as primary and secondary therapy in open angle glaucoma in Indian patients

AIMS: To study the efficacy of argon laser trabeculoplasty (ALT) as a primary and secondary therapy in Indian patients with primary open angle glaucoma (POAG). METHODS: ALT was performed as a primary therapy in 40 eyes of 21 patients newly diagnosed with POAG (group I) and as a secondary therapy in 39 eyes of 21 patients who had been taking topical antiglaucoma medications for more than 1 year. The best corrected visual acuity, baseline intraocular pressure (IOP), diurnal variation of IOP, anterior chamber angles, and visual fields were the various parameters evaluated before and after performing ALT. Follow up visits were scheduled at 24 hours, 1 week, 1 month, 3 months, 6 months, and 1 year after the surgery. The patients were recalled at the end of 5 years for the final follow up examination. Success of ALT was defined as IOP 相似文献   

Selective laser trabeculoplasty

Selective laser trabeculoplasty (SLT) has been shown to be safe, well tolerated, and effective in intraocular pressure (IOP) reduction as therapy in several forms of open-angle glaucoma. The preservation of trabecular meshwork (TM) architecture and the demonstrated efficacy in lowering IOP make SLT a reasonable and safe alternative to argon laser trabeculoplasty (ALT). SLT may also be effective for cases of failed ALT and is a procedure that may also be repeatable, unlike ALT. SLT is also a simple technique for an ophthalmologist to learn as the large spot size eliminates the need to locate a particular zone of treatment on the TM. SLT has been demonstrated to be effective as primary treatment for open angle glaucoma and can be an effective adjunct in the early treatment of glaucoma. Furthermore, SLT can be considered as a primary treatment option in patients who cannot tolerate or who are noncompliant with their glaucoma medications, without interfering with the success of future surgery.     

Nd:YAG laser trabeculopuncture (YLT) for glaucoma with traumatic angle recession

Traumatic angle recession caused by blunt trauma often induces uncontrollable glaucoma despite the maximum medical therapy tolerated, such as argon laser trabeculoplasty (ALT), with no or little benefit. Therefore, instead of ALT, we tried Nd:YAG laser trabeculopuncture (YLT) on 11 patients with this type of glaucoma. The intraocular pressure of these patients was followed up for 15 ± 7 months (average ± SD). In 6 of 7 eyes treated initially with YLT, the IOP was significantly reduced, so medication was discontinued. Four other cases with uncontrollable IOP after failed ALT were treated with YLT. The IOP of 3 cases was successfully controlled by medication after YLT. These YLT results were then compared with those of ALT in 11 glaucoma patients with traumatic angle recession. Seven of 11 cases treated initially with ALT failed in less than 3 months, and surgical intervention or additional laser treatments were required. The probability of success from the time-series analysis at 12 months after each laser application was 0.909 in YLT, 0.273 in ALT. YLT offers significant advantages over ALT for the treatment of glaucoma with traumatic angle recession after blunt trauma and thus merits further study.     

Argon laser trabeculoplasty in special forms of open-angle glaucoma

Argon laser trabeculoplasty was performed in 71 eyes with complicated forms of open-angle glaucoma and insufficiently regulated intraocular pressure. The follow-up time was 18 +/- 6 months. The success rate was 35% in the group with secondary forms of glaucoma (37 treated eyes). Depending on the special indication a great difference in the subgroups was noted: the ALT failed in 4 cases of glaucoma after trauma, but was successful in 45% of all cases of aphakic glaucoma. Thirty-four eyes were treated by ALT after trabeculectomy had failed. The success rate in this group was 71%.     

Gonioretraction using argon laser

Argon laser trabeculoplasty (ALT) has recently become one of the most popular procedures in the treatment of chronic open angle glaucoma. Although ALT is quite efficient, its mode of action is far from understood and the rate of complications or side effects is not negligible. In 1981 we began exploring a different procedure that we have called argon laser gonioretraction (ALG) with reference to the Cairns surgical goniospasis. While the corneo-scleral trabeculum is the target for argon laser beams in ALT, in ALG the beams are directed toward the ciliary band in an attempt to get the scar to pull the scleral spur backwards and stretch the trabeculum. The procedure may also act through the uveal trabeculum. The procedure was first utilized from 1981 to 1983 in 43 chronic open angle glaucoma eyes with: 1/ a high rate of success in decreasing the intraocular pressure on a long term basis, 2/ an acceptable rate of complications. 18 months after laser surgery, intraocular pressure was fully controlled without any medical treatment in 19 cases (44%). 18 additional cases (42%) were controlled with the help of less medical treatment than before. In 4 cases (8%) the failure was complete including one case with significant prolonged and non-responsive post-op hypertension which has induced a slight alteration of the visual field. One case was lost to follow-up. Supposed advantages of ALG over ALT are: integrity of the corneo-scleral trabeculum is maintained, goniosynechiae are more peripheral, and there is less propensity to induce proliferation of endothelial cells.     

Results 1 year after trabeculoretraction by 360 degree argon laser in the treatment of open-angle glaucoma

On 210 glaucomatous patients (119 men, 91 women), 390 eyes with open angle chronic glaucoma, we have performed an argon laser trabeculoplasty according to Wise technique (360 degrees in one time). ALT was presented as an alternative to surgery. Therefore results were appreciated so that ALT allowed or not to avoid surgery. After one year, the rate of failures was: on all the 390 eyes: 15 p. cent on O.A.C.G. simplex: 6.7 p. cent on myopic glaucoma: 7 p. cent on pigmentary glaucoma: 29.5 p. cent on capsular glaucoma: 6 p. cent after trabeculectomy: 62 p. cent on aphakic glaucoma: 50 p. cent on secondary glaucoma: 33 p. cent on combined glaucoma: 0 p. cent In the group of successful results, ALT allowed to lower medical treatment in at less 70 p. cent after one year of follow-up except for pigmentary glaucoma where, in almost all cases, medication before ALT had to be continued.     

Sympathetic ophthalmia as a complication of argon laser trabeculoplasty

The results of argon laser trabeculoplasty (ALT) in a series of 254 eyes are presented with a follow-up of over five years. ALT was effective in lowering the IOP in most cases of primary open angle glaucoma (56.3%). Several complications were observed. These included anterior uveitis, hemorrhage, formation of peripheral anterior synechiae, elevation of IOP. The most serious complication observed was presumed sympathetic ophthalmia in an aphakic eye with uveitic glaucoma 12 months after ALT.