Офтальмохирургия (Oct 2015)
YAG LASER ACTIVATION OF TRABECULA IN TREATMENT OF PATIENTS WITH PRIMARY OPEN-ANGLE GLAUCOMA
Abstract
Purpose. To study an efficiency of YAG laser activation of trabecula (YAG-LAT) in treatment of patients with primary open angle glaucoma (POAG) in case of a low pigmentation in anterior chamber angle (ACA) structures.Material and methods. The clinical study included 90 patients (98 eyes) with the initial and the advanced POAG stages, the degree of ACA structures pigmentation was 0-1. The average age of the patients was 64.9±9.1 years of them: female – 59 (66%), male – 31 (34%). All patients were divided into 2 groups. The group 1 consisted of 46 patients (50 eyes) who underwent the YAG-LAT. The (comparative) group 2 included 44 patients (48 eyes) where only a local hypotensive therapy was performed. The preoperative level of intraocular pressure (IOP)(by Maklakov) was mean 26.5±1.4mmHg in the group 1, Ро – 23.03±1.3. The mean IOP level in the group 2 was 26.8±1.3mmHg, Ро – 22.9±1.4.Results. No intra-operative complications were noted during laser procedures. In the long-term follow-up (from 12 to 24 months) after the YAG-LAT the IOP level remained within normal limits in 88% of cases (44 eyes out of 50), in 4 patients (4 eyes out of 50 – 8%) the ophthalmotonus normalization was achieved by a repeated YAG-LAT 16-18 months after the first laser intervention, in 2 patients (2 eyes out of 50 – 4%) the IOP normalization was achieved by an enhance of hypotensive therapy. In patients of the group 2 the ophthalmotonus level normalization was obtained in 40 eyes out of 48 – 83%, in 5 patients the hypotensive regimen was enhanced, 3 patients needed a surgical intervention – micro-invasive non-penetrating deep sclerectomy in the follow-up of 20-24 months. During the entire follow-up the condition of visual functions remained stable in the majority of patients: 80% of cases in the group 1, 77% – in the group2. Avisual acuity decrease in patients on average by 0.18±0.12 by the end of the follow-up was explained by a development or progression of cataract. The narrowing of peripheral visual field by 5-10 degrees was noted in patients with advanced stage of glaucoma in 4% of cases (2 eyes out of 50) by the end of the follow-up after the YAGLAT, in 6% of cases (3 eyes out of 48) in the comparative group. Any progression of glaucomatous process with a transition into a subsequent stage was not revealed.Conclusion. The YAG laser activation of trabecula is a safe and effective method of treatment in patients with the initial and the advanced POAG stages in case of low pigmentation in ACA structures.
