Офтальмохирургия (Oct 2015)
LASER ACTIVATION OF TRABECULA IN TREATMENT OF PRIMARY OPEN-ANGLE GLAUCOMA
Abstract
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.
