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Impressum
Influence of selective laser trabeculoplasty (SLT) on intraocular pressure in pseudoexfoliation syndrom (PEX)
Pecold-Stepniewska H., Wasiewicz-Rager J.
Eye Klinik, K. Marcinkowski Academy of Medical Sciences, Poznan, Poland
Purpose: to analyze the influence of SLT on intraocular pressure
(IOP) in patients with medically uncontrolled glaucoma in PEX- syndrom
Methods: A prospective clinical trial was designed: 17 patients
(9 female, 8 male, 19 eyes) with glaucoma in PEX- syndrom treated with
SLT entered the study. The average age of patients was 68,5 years (41-81
). The primary IOP without treatment was between 28- 51 mm Hg (mean 40,8
mmHg +/- 10,1), the IOP measured directly before SLT was between 18-45
mm Hg (mean 27,2 mm Hg +/- 6,6). All patients had been using an antiglaucomatous
therapy, which was continued after laser therapy. The trabecular meshwork
was pigmented from ++ to ++++ in 5 grade scale. The patients were treated
with SLT 180 to 270 grades in pigmented meshwork with 50 impulses, mean
total energy being 29,03 mJ +/-5,4. The IOP was evaluated at 1 hour, 24
hour, 1 week, 1, 3 ,6 12 and 18 months after treatment.
Results: The mean IOP drop from the pretreatment values was -2,6+/-7,7
mm Hg after 1 hour,- 9,2+/-3,2 mm Hg after 24 hours, - 7,09+/-3,3 mm Hg
after 1 week, -7,35+/-4,2 mm Hg after 1 month, - 7,55+/-8,3 mm Hg after
3 months, - 8,9+/-2,8 mm Hg after 6 months, -9,9+/-4,2 mm Hg after 12
months, -9,2+/- 4,3 mm Hg after 18 months. Additionally, all patients
had to use local antiglaucomatous treatment. Due to unsatisfactorily reduced
IOP 4 eyes had to be operated (trabeculectomy alone or combined with cataract
extraction) after 6 months and 6 eyes after 18 months. There was no significant
correlation between the amount of pigment on the trabecular meshwork and
the IOP fall.
Conclusions: SLT seems to be a safe and effective method to lower
IOP in patients with glaucoma in PEX . However, its effective only in
the limited range of primary IOP and in the limited time. According to
the pathomechanism of selective action on pigmentary meshwork, we expected
a better effect of IOP reduction in glaucoma with PEX which is characterized
by larger amount of pigmentation than POAG.