Initial Laser Trabeculoplasty Research Articles

Current management of glaucoma.

This study reviews current concepts in the goals of glaucoma therapy, interventional sequence, and options for the management of glaucoma in light of recent clinical trials. Recent randomized prospective trials of ocular hypertension and glaucoma have provided evidence for more specific treatment goals in glaucoma therapy. In addition, the advent of the prostaglandin analogs, advances in laser technology, and innovative techniques for filtering surgery have expanded the armamentarium that ophthalmologists use in the treatment of glaucoma. Despite continued advances in laser and incisional surgery, medical therapy still appears to be the primary means by which intraocular pressure is controlled. Initial medical therapy has changed with the introduction of prostaglandin analogs, which are replacing beta-antagonists as the drug of first choice. Laser trabeculoplasty, using either photocoagulative (argon and diode) or photodisruptive (frequency doubled Nd:YAG) lasers, is still reserved for patients who do not improve with medical therapy, although there is good evidence that initial laser trabeculoplasty is just as effective as initial medical therapy. Trabeculectomy with antifibrotic agents (5-fluorouracil or mitomycin C) is still the next step in intraocular pressure control, and glaucoma drainage implants are reserved for refractory cases. Cyclophotocoagulation is a last resort procedure because of poor visual outcomes and is reserved for patients with intractable pain and vision thought not to be useful.

Long-term reduction of intraocular pressure after repeat argon laser trabeculoplasty.

Thirty-eight eyes (in 31 patients with glaucoma) that had shown a favorable response to an initial argon laser trabeculoplasty had a repeat laser trabeculoplasty four to 81 months (mean +/- S.E.M., 23 +/- 3 months) later because of inadequately controlled intraocular pressures. A mean (+/- S.E.M.) of 65 +/- 3 burns (range, 50 to 115) were given during the initial laser trabeculoplasty, and 58 +/- 2 burns (range, 36 to 100) were given during the first repeat treatment. Three months after the first repeat laser trabeculoplasty, one eye (3%) had undergone filtering surgery and 30 eyes (78%) were considered successes. Of the 30 eyes that were followed up for 12 months after the first repeat laser trabeculoplasty, two (7%) had undergone filtering surgery, three (10%) had received a second repeat laser trabeculoplasty, and 22 (73%) were successes. Fifteen eyes underwent a second repeat laser trabeculoplasty at six to 47 months (mean +/- S.E.M., 21 +/- 3 months) after the first repeat laser trabeculoplasty. Seven (47%) of these eyes required filtering surgery within three to 12 months after the second repeat laser trabeculoplasty. Four of 38 (11%) of the initial, two of 38 (5%) of the first repeat, and zero of 15 of the second repeat laser trabeculoplasty treatments resulted in a one- to two-hour rise in intraocular pressure of at least 10 mm Hg.

Long-Term Reduction of Intraocular Pressure After Repeat Argon Laser Trabeculoplasty

Thirty-eight eyes (in 31 patients with glaucoma) that had shown a favorable response to an initial argon laser trabeculoplasty had a repeat laser trabeculoplasty four to 81 months (mean ± S.E.M., 23 ± 3 months) later because of inadequately controlled intraocular pressures. A mean (± S.E.M.) of 65 ± 3 burns (range, 50 to 115) were given during the initial laser trabeculoplasty, and 58 ± 2 burns (range, 36 to 100) were given during the first repeat treatment. Three months after the first repeat laser trabeculoplasty, one eye (3%) had undergone filtering surgery and 30 eyes (78%) were considered successes. Of the 30 eyes that were followed up for 12 months after the first repeat laser trabeculoplasty, two (7%) had undergone filtering surgery, three (10%) had received a second repeat laser trabeculoplasty, and 22 (73%) were successes. Fifteen eyes underwent a second repeat laser trabeculoplasty at six to 47 months (mean ± S.E.M., 21 ± 3 months) after the first repeat laser trabeculoplasty. Seven (47%) of these eyes required filtering surgery within three to 12 months after the second repeat laser trabeculoplasty. Four of 38 (11%) of the initial, two of 38 (5%) of the first repeat, and zero of 15 of the second repeat laser trabeculoplasty treatments resulted in a one- to two-hour rise in intraocular pressure of at least 10 mm Hg.