Комбинированный метод лазерного лечения первичной узкоугольной (смешанной) глаукомы

Abstract

Purpose. To study the efficiency of a combined method for laser treatment – the laser iridectomy in combination with the selective laser trabeculoplasty (LIE+SLTP) – in patients with primary narrow-angle (mixed) glaucoma. Material and methods . The study included 72 patients (72 eyes) with initial stage of primary narrow-angle (mixed) glaucoma. The average age of the patients was 65.1±6.56 years: 27 males, 43 females. The followup period was up to 4 years after laser treatment. The level of intraocular pressure (Р 0 ) before the treatment was on average 24.47±1.85mmHg. The mean quantity of antihypertensive drugs used by the patients before the laser operation was 2.2±0.4. Stages of the combined treatment: laser iridectomy and selective laser trabeculoplasty were performed immediately one after the other in all patients. Results. All laser interventions were carried out without complications.An extension of the anterior chamber angle (ACA) was achieved in all patients, which was confirmed by data of gonioscopy and anterior optical coherence tomography (OCT). On the 1st day after the combined laser treatment, the reactive elevation of IOP was observed in 9.7% of cases and was stopped by an additional antihypertensive therapy within 1-2 days. Other complications such as inflammatory, hemorrhagic were not detected. A week after laser treatment there was a significant decrease (p<0.05) of intraocular pressure (IOP) by 6.9mmHg on average (28.2%) of the original. In the long-term postoperative follow-up period, the average decrease of IOP was 23.4%. Ophthalmotonus normalization occurred with increasing the coefficient of aqueous humor outflow facility (C) from 0.09±0.01 to 0.18±0.01 (p<0.05). In the long-term postoperative follow-up the IOP normalization was achieved in 87.5% of cases (63 eyes of 72). The IOP decrease to normal occurred in 9 eyes after the repeated SLT. The average number of antihypertensive agents that were used by the examined patients after the treatment decreased and averaged 1.02±0.1. The visual acuity remained unchanged in 80.5% of cases. The decrease of the vision was due to the progression of complicated cataract. Limits of peripheral visual field remained stable by the end of the follow-up period in 96% of cases. Within the observation period, according to computer perimetry data, negative dynamics was recorded in 6 patients (6 eyes out of 72 – 8.3%). According to HRT, negative dynamics in the form of a decrease in the volume of the neural rim, an increase in the area of the optic disc excavation was noted in 7% of cases (5 eyes of 72). Conclusion. The proposed method of combined laser treatment allows to achieve the IOP normalization due to an expansion of ACA after LIE with a subsequent activation of trabecula by SLT in 87.5% of patients. Ophthalmotonus normalization, stabilization of visual functions and indicators of the optic nerve conditions in the vast majority of patients in the long-term postoperative period proves the efficiency of the proposed technique in the treatment of patients with the initial stage of primary narrow-angle (mixed) glaucoma. The simultaneous operation of two stages – laser iridectomy and SLT is safely and enables significantly to reduce the duration of treatment and rehabilitation of patients.