Abstract
BackgroundTo evaluate the influence of Selective Laser Trabeculoplasty (SLT) on iStent inject® outcomes in open-angle glaucoma (OAG).MethodsIn this retrospective comparative cohort outcome study, 66 patients who were treated with two iStent inject® devices were included. Patients were divided into two subgroups consisting of patients without SLT treatment prior to surgery and patients who had been treated previously with 360° SLT but without sufficient response. Outcome measures included intraocular pressure (IOP) and number of antiglaucoma medications after 6 weeks with three, six, 12, and 24 month follow-ups.ResultsMean preoperative IOP decreased from 20.4 ± 5.3 mmHg to 14.8 ± 3.0 mmHg for patients without SLT treatment prior to surgery (p = 0.001) and from 19.2 ± 4.5 mmHg to 14.0 ± 1.6 mmHg for patients with insufficient response to 360° SLT treatment (p = 0.027) at 12 months after iStent inject® implantation. No significant difference was found between the two groups (p > 0.05). The number of antiglaucoma medications did not change in both groups (p > 0.05) and showed no significant difference between the two groups (p > 0.05).ConclusionPrior SLT treatment seems to have no negative influence on the IOP lowering-effect of iStent inject® implantation in patients with OAG. It is therefore an appropriate incremental procedure with no exclusion criterion for an iStent inject® implantation.
Highlights
To evaluate the influence of Selective Laser Trabeculoplasty (SLT) on iStent inject® outcomes in openangle glaucoma (OAG)
The following was performed for each patient: a complete ophthalmological examination – including a medical history review – best corrected visual acuity (BCVA) measurement tested with a Snellen chart, slitlamp examination, intraocular pressure (IOP) measurement using Goldmann’s applanation tonometry, gonioscopy, dilated fundus examination, stereoscopic photographs of the optic disc, a baseline bilateral standard automated perimetry threshold visual test using the 30–2 Tendency-Oriented Perimetry (TOP) programme (Octopus, Haag-Streit), and a baseline peripapillary retinal nerve fibre layer (RNFL) thickness measurement by Spectralis optical coherence tomography (OCT) (Spectralis OCT, Heidelberg Engineering GmbH, Heidelberg, Germany)
Between June 2014 and February 2016, 193 eyes of 170 patients diagnosed with moderate OAG who underwent Micro-invasive glaucoma surgery (MIGS) with implantation of two iStent inject® devices were screened for the study
Summary
To evaluate the influence of Selective Laser Trabeculoplasty (SLT) on iStent inject® outcomes in openangle glaucoma (OAG). The method uses a 532 nm Nd:YAG laser to target the pigmented cells of the trabecular meshwork [1]. Several studies demonstrated that SLT is an efficient and safe method to reduce sustainably the IOP in glaucoma patients [1,2,3,4,5,6,7,8,9,10,11,12,13], the mechanism remains uncertain. In contrast to the argon laser trabeculoplasty (ALT), histologic and ultrastructural studies found less extensive damage and no coagulative effects on the trabecular meshwork after SLT [12, 15, 16]. In-vitroexperiments showed an increase in pro-inflammatory cytokine expression [12, 18]
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