Laser activation of trabecula in treatment of primary open-angle glaucoma

    ABSTRACT

    

    Laser activation of trabecula in treatment of primary open-angle glaucoma

    

    T.V. Sokolovskaya, A.V. Doga, D.A. Magaramov, Y.A. Kochetkova

    

    The S. Fyodorov Eye Microsurgery Federal State Institution, Moscow

    

    Purpose. To evaluate clinical and functional results of the YAG laser activation of trabecula (YAG-LAT) in the treatment of patients with the primary open-angle glaucoma (POAG) in case of pronounced pigmentation in structures of the anterior chamber angle (ACA) in a comparative aspect.

    Material and methods. There were in our fellow-up 94 patients (102 eyes) with the initial and the advanced POAG stages, the pigmentation degree of the ACA structures was 2-3. The mean age of patients was 66.3±8.1 years, male – 32 (34%), female – 62 (66%). The follow-up was up to 3 years. All patients were divided into 2 groups. The group 1 included 49 patients (52 eyes) who underwent the YAG-LAT. The group 2 (the comparative group) consisted of 45 patients (50 eyes) who underwent the selective laser trabeculoplasty (SLT). In the group 1 the IOP level (by Maklakov) preoperatively ranged from 24 to 30mmHg (mean IOP – 26.7±1.3mmHg), Po – from 19.5 to 27mmHg (mean level – 22.9±1.5). In the group 2 the IOP level (by Maklakov) before the SLT ranged from 25 to 35mmHg (mean IOP – 26.8±1.9mmHg), Po – from 21 to 30.8mmHg (mean level – 23.1±1.9).

    Results. There were not noted any intra-operative complications during the laser interventions. In the long-term follow-up (from 12 to 36 months) in the group 1 the IOP level remained within normal limits in 81% of cases (42 eyes out of 52), the ophthalmotonus normalization was achieved by the repeated YAG-LAT 17-23 months after the first operation in 8 patients (8 eyes of 52-15%), the IOP normalization was achieved by a hypotensive therapy intensity in 2 eyes of 52 (4%). In the long-term follow in patients of the group 2 after SLT the ophthalmotonus normalization was achieved in 43 of 50 eyes – 86%, 5 patients (5 out of 50 eyes – 10%) required the re-operation 18-25 months after the first SLT, the instillation mode was intensified in 2 patients (2 out of 50 eyes – 4%).

    Within the whole follow-up the state of visual functions remained stable in the majority of patients in 78% of cases in the group 1, in 83% of cases in the comparative group.

    Limits of the peripheral visual field remained stable in 96% of cases (50 out of 52 eyes) in patients of the group 1, – in 94% of cases (47 out of 50 eyes) in the group after SLT.

    During the follow-up according to the computer perimetry data a negative dynamics was detected in 3 patients (3 out of 52 eyes – 6%) after the YAG-LAT, in 2 patients (2 out of 50 eyes – 4%) in the comparative group.

    According to the HRT a negative dynamics in the form of a reduction in the volume of neural rim and an extension of the cupping area was revealed in 3 patients (3 out of 52 eyes – 6%) after the YAG-LAT and in 4 patients (4 out of 50 eyes – 8%) after the SLT by the end of the fellow-up.

    Conclusion. The YAG-laser activation of trabecula is an efficient method of treatment for the initial and the advanced stages of primary open-angle glaucoma in case of severe pigmentation in structures of the anterior chamber angle. The YAG-LAT results were less stable compared with the SLT, because a repeated laser procedure was required in a more quantity of cases.

    Key words: laser activation of trabecula, selective laser trabeculoplasty, intraocular pressure, laser treatment of glaucoma.