Laser trabeculoplasty - the first choice surgery for treatment of primary open angle glaucoma

Abstract

Aim. To analyze the results of laser trabeculoplasty in patients with first and second stage of primary open angle glaucoma with the disease duration over 6 years depending on nature of sclera sinus blockade. Methods. 251 patients aged 38 to 78 years (121 female, 130 males, 285 eyes) with primary open angle glaucoma were observed. The early stage of the disease was observed in 188 eyes, promoted stage of the disease - in 97 eyes. Hypertension, atherosclerosis, diabetes mellitus were among the comorbidities. Visual acuity testing, visual field testing, ocular tonometry and tonography, ophthalmoscopy were performed, sclera sinus blockade features were defined. Laser trabeculoplasty was performed with an argon laser using the universal three mirror lens (600 to 1000 mW, laser beam diameter 50 μm, exposure time 0.1 sec, average number of iterations - 100). Laser linear trabeculoplasty by Wise modified by Mamedov was performed. In case of narrow anterior chamber angle an additional laser gonioplasty by Krasnov and laser peripheral iridotomy were performed prior to trabeculoplasty. Results. In patients with the first stage of the disease in case of a functional blockade the remote hypotensive effect was reached in 81.7% of cases, in case of organic blockade - in 46.7% of cases. In the second stage of an open angle glaucoma decrease in intraocular pressure in functional blockade was reached in 65% of cases, in organic blockade - in 33.3% of cases. Visual acuity decreased in 22.1% of cases. In patients with sclera sinus functional blockade the remote hypotensive effect was twice as better compared to patients with organic blockade. Visual field stabilization in patients with organic blockade was achieved 5.5 times rarely compared to patients with functional blockade. Conclusion. Laser linear trabeculoplasty is still the first choice surgery for primary open angle glaucoma treatment. Defining the nature of sclera sinus blockade allows to predict the laser trabeculoplasty results.