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

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

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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.

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.

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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).

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Authors and Affiliations

  1. Augenklinik, UniversitätsSpital Zürich, Frauenklinikstr. 24, 8091, Zürich, Schweiz

    C. Hirn, S.A. Zweifel, M. Töteberg-Harms & J. Funk

  2. NIHR BRC for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK

    C. Hirn

  3. Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, USA

    M. Töteberg-Harms

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  1. C. Hirn
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  2. S.A. Zweifel
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  3. M. Töteberg-Harms
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  4. J. Funk
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Correspondence to C. Hirn.

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___ ___

Dieses Manuskript basiert auf einem Vortrag gehalten auf dem 108. Kongress der Deutschen Ophthalmologischen Gesellschaft 2010.

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Hirn, C., Zweifel, S., Töteberg-Harms, M. et al. Wirksamkeit der selektiven Lasertrabekuloplastik bei Patienten mit unzureichender Augendrucksenkung unter maximaler Therapie. Ophthalmologe 109, 683–690 (2012). https://doi.org/10.1007/s00347-012-2593-0

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