Long-Term Effect of Selective Laser Trabeculoplasty on Intraocular Pressure in Pseudoexfoliation Glaucoma

 

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Abstract

Background: Selective laser trabeculoplasty has been found to be effective as an adjunct to topical medical therapy in glaucoma. This analysis examines the intraocular pressure lowering effect of laser trabeculoplasty in eyes with pseudoexfoliation on maximum medical therapy. Material and Methods: A retrospective chart review was undertaken of 457 eyes of which 344 underwent a 360° selective laser trabeculoplasty treatment between 2008 and 2013. 94 of these eyes had pseudoexfoliation. Intraocular pressure values were analysed in 3 monthly intervals up to 60 months after selective laser trabeculoplasty. Exclusion criteria were narrow or closed angles as well as uveitic glaucoma and previous intraocular pressure lowering surgery. Results: Patients mean age was 71 years ± 11.0 SD, 42.7 % were male. At time point 12 months after selective laser trabeculoplasty the intraocular pressure lowering effect was significantly greater in eyes with pseudoexfoliation than in eyes without pseudoexfoliation (p = 0.01; Mann-Whitney test). Up to 21 months after selective laser trabeculoplasty a significant intraocular pressure reduction of 2.76 mmHg ± 3.72 SD compared to baseline values could be seen in eyes with pseudoexfoliation (p = 0.01; Wilcoxon Test). Conclusions: In this retrospective study a significant greater intraocular pressure lowering effect of selective laser trabeculoplasty could be seen in eyes with pseudoexfoliation compared to eyes without pseudoexfoliation only at time point 12 months after selective laser trabeculoplasty. Analyses revealed no significant intraocular pressure reduction compared to baseline values after 21 months in eyes with pseudoexfoliation and after 30 months in eyes without pseudoexfoliation.

Zusammenfassung

Hintergrund: Die Selektive Laser Trabekuloplastik ist eine wirksame Ergänzung der topischen medikamentösen Intraokulardrucksenkertherapie. Diese retrospektive Analyse untersucht die Intraokulardruck senkende Wirkung der Laser Trabekuloplastik bei Patienten mit Pseudoexfoliation unter maximaler Lokaltherapie. Material und Methoden: Retrospektive Studie über 457 Augen, von denen 344 zwischen 2008 und 2013 mit einer selektiven Laser Trabekuloplastik über 360° behandelt wurden. 94 Augen hatten Pseudoexfoliation. Die Intraokulardruckwerte wurden in 3 Monatsintervallen bis 60 Monate nach Intervention analysiert. Ausschlusskriterien waren Engwinkel-, Winkelverschluss- oder uveitisches Glaukome und vorgängige drucksenkende Eingriffe. Ergebnisse: Das mittlere Patientenalter betrug 71 Jahre ± 11,0 SD; 42,7 % männlich. Die Intraokulardrucksenkung war zum Zeitpunkt 12 Monate nach selektiver Laser Trabekuloplastik in der Gruppe der Augen mit Pseudoexfoliation (n = 94) signifikant stärker als bei Augen ohne Pseudoexfoliation (n = 250) (p = 0,01; Mann-Whitney Test). Bis 21 Monate nach selektiver Laser Trabekuloplastik zeigte sich in Augen mit Pseudoexfoliation eine signifikante Intraoculardrucksenkung um 2,76 mmHg ± 3,72 SD gegenüber dem Ausgangs-Wert (p = 0,01; Wilcoxon Test). Schlussfolgerungen: In dieser retrospektiven Studie konnte lediglich zum Zeitpunkt 12 Monate nach selektiver Laser Trabekuloplastik eine signifikant stärkere Intraokulardrucksenkung bei Augen mit Pseudoexfoliation gegenüber Augen ohne Pseudoexfoliation gefunden werden. Nach 21 Monaten konnte in Augen mit Pseudoexfoliation keine signifikante Intraokulardrucksenkung gegenüber dem Ausgangswert mehr festgestellt werden, was in Augen ohne Pseudoexfoliation nach 30 Monaten ebenso der Fall war.

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