Previous Laser Trabeculoplasty Research Articles

ZEISS VISULAS green SLT in primary open‐angle glaucoma and ocular hypertension: 6 month follow up in a real‐world setting

Aims/Purpose: The aim of this study is to report preliminary data of efficacy and safety of ZEISS VISULAS® green Selective Laser Trabeculoplasty (SLT) in primary open‐angle glaucoma (POAG) and ocular hypertension (OHT) in a real‐life clinical setting.Methods: We prospectively collected data of 34 treated eyes in 17 patients during 2022. Patients followed a regular clinical management in our center (San Giuseppe Hospital, University Eye Clinic, IRCCS Multimedica, Milan, Italy). Follow up was of 6 months. Inclusion criteria were adult patients, diagnosis of POAG or OHT. Exclusion criteria were previous laser trabeculoplasty (LT), filtration surgery, and cyclophotocoagulation procedures. Main outcome was ≥20% intraocular pressure (IOP) reduction at 6 months. All the procedures were performed by two doctors (CB, DT). Adverse events were recorded.Results: We included 34 eyes of 17 patients. Mean age was 67.4 ± 11.5 years. Patients were 88.2% Caucasian, 47.1% females, with a diagnosis of OHT (64.7%), mild POAG (29.4%), or moderate POAG (5.9%). The mean IOP was significantly decreased from baseline to 6 months (21.5 ± 2.1 vs 18.0 ± 2.6 mmHg, p < 0.05). Primary outcome (≥ 20% IOP reduction at 6 months) was reached in 52.9% cases. There was no significant increase in glaucoma medical therapy at 6 months (1.1 ± 1.0 vs 1.4 ± 1.0 medication per eye, p = 0.23). No patient received a second SLT treatment or underwent filtration surgery or cyclophotocoagulation procedures during the follow‐up. No major ocular or systemic side effects were found. The most common adverse event was ocular discomfort in 10 cases (29.4%), always mild and transient. SLT treatment was performed with an average of 100.2 ± 6.7 spots, 27.4 ± 4.7 μJ energy, and a 360° distribution for 32 of 34 eyes (2 eyes treated at 270°).Conclusions: We reported the preliminary short‐term data of efficacy and safety of ZEISS VISULAS® green SLT treatment in POAG and OHT. To the best of our knowledge, this is the first report of ZEISS VISULAS® green SLT in a real‐life clinical setting. This technology has been shown to be effective and safe in lowering IOP at 6 months after the treatment. Limits of this study were the small sample size and the short follow‐up time.

Combined laser treatment of glaucoma

To study the effectiveness of non-penetrating hypotensive laser sclerotomy (NHLS) in patients with non-stabilized primary open-angle (I-III) b glaucoma with previous laser trabeculoplasty and who are receiving drug therapy. The study included 54 patients (102 eyes) with initial (38 eyes), developed (46 eyes) and advanced (18 eyes) glaucoma who were examined and operated on. 26 patients (46 eyes) were instilled a combined drug containing brinzolamide and timolol, 28 patients (56 eyes) received prostaglandin F2α analogues (PGA). Intraocular pressure (IOP) levels were 27±2.4 mm Hg. Reduction of IOP was observed in 89% of patients 2 weeks after NHLS with gradual improvement during the first 3 months of the follow-up; in 71% of patients the results preserved by the 6th month. Patients receiving combination of brinzolamide and timolol had more pronounced IOP reduction after NHLS amounting to 2.4±1.8 mm Hg in the first 3 months. By the end of the observation period IOP levels remained within normal range, drug therapy was ceased in 16 patients (21 eyes, 20.6%), 32 patients (67 eyes, 65.7%) achieved normalized intraocular pressure with antihypertensive therapy, and 9 patients (9 eyes, 8.8%) were referred to surgical treatment. Non-penetrating hypotensive laser sclerotomy (NHLS) allows measured reduction of IOP in various glaucoma stages achieving controlled and persistent hypotensive effect. In the group of patients receiving combination of brinzolamide and timolol, the effect is statistically significant and clinically superior when compared with patients receiving PGA.

Risk factors for acute postoperative intraocular pressure elevation after phacoemulsification in glaucoma patients

To evaluate the risk factors for and frequency of an acute intraocular pressure (IOP) elevation (spike) after phacoemulsification in patients with glaucoma. Academic glaucoma clinics and operating rooms. Retrospective case series. Charts of consecutive glaucoma patients without previous incisional glaucoma surgery having phacoemulsification by the same surgeon between August 1996 and July 2012 were reviewed to obtain demographic information, preoperative glaucoma medications, severity and treatment measures, intraoperative course, and postoperative outcomes. A postoperative IOP spike was defined as IOP greater than 50% above baseline IOP. Main outcome measures were the number of eyes with a postoperative IOP spike and risk factors associated with an IOP spike after phacoemulsification. Of 271 eyes (271 patients) included in the study, 45 (17%) had an IOP spike. Risk factors for postoperative IOP spike by multivariate analysis included longer axial length (AL) or associated characteristics (wider angle grade on gonioscopy, deeper anterior chamber, and male sex), higher number of preoperative IOP-lowering medications, previous laser trabeculoplasty, and lack of postoperative oral acetazolamide. One eye (0.4%) required trabeculectomy during the 90-day postoperative period. A significant proportion of glaucoma patients having phacoemulsification had an IOP spike. Patients requiring a higher number of IOP-lowering medications or laser trabeculoplasty for IOP control preoperatively and those with a greater AL should be treated more aggressively with IOP-lowering medication in the immediate postoperative period. No author has a financial or proprietary interest in any material or method mentioned.

Impact of Laser Trabeculoplasty on Trabectome ® Outcomes

To report the impact of prior laser trabeculoplasty on clinical outcomes of Trabectome (NeoMedix Corporation, Tustin, CA) surgery. This is a retrospective, non-comparative study of consecutive cases of Trabectome surgery with 36 months of follow-up. Main outcome measures were intraocular pressure (IOP), number of glaucoma medications, and the occurrence of secondary procedures. In the trabeculoplasty group, mean IOP measured 16.5 +/- 4.0 mm Hg with an average decrease of 24% from preoperative IOP at 12 months. In eyes without previous trabeculoplasty, IOP measured 15.7 +/- 3.0 mm Hg with an average decrease of 30% at 12 months. Adjunctive medications decreased to 2.1 and 1.5 glaucoma medications, respectively. Secondary procedures were performed in 12% and 10% of eyes in each group. Previous laser trabeculoplasty does not appear to significantly impact IOP, but may increase the need for glaucoma medication in patients undergoing Trabectome surgery.

Sudden visual loss after uneventful cataract surgery*1Snuff syndrome

We describe a case in which the patient had routine, uneventful cataract surgery and developed snuff syndrome on day 1 postoperatively. The patient had pseudoexfoliation syndrome and normal intraocular pressure that was well controlled by timolol and previous laser trabeculoplasty. Although the visual result had been good after surgery in the first (right) eye with a best corrected visual acuity (BCVA) of 6/5, this adverse event, which decreased the BCVA in the left eye from 6/24 preoperatively to hand movements postoperatively, was unexpected. Systemic evaluation failed to identify a specific cause. Data were collected prospectively on 1000 subsequent, consecutive cases of cataract surgery, but we were unable to find pathogenetic data on this occurrence.

Sudden visual loss after uneventful cataract surgery: Snuff syndrome

We describe a case in which the patient had routine, uneventful cataract surgery and developed snuff syndrome on day 1 postoperatively. The patient had pseudoexfoliation syndrome and normal intraocular pressure that was well controlled by timolol and previous laser trabeculoplasty. Although the visual result had been good after surgery in the first (right) eye with a best corrected visual acuity (BCVA) of 6/5, this adverse event, which decreased the BCVA in the left eye from 6/24 preoperatively to hand movements postoperatively, was unexpected. Systemic evaluation failed to identify a specific cause. Data were collected prospectively on 1000 subsequent, consecutive cases of cataract surgery, but we were unable to find pathogenetic data on this occurrence.

Primary Trabeculectomy in Young Adults: Long-term Clinical Results and Factors Influencing the Outcome

To assess the long-term clinical outcome of primary trabeculectomy in young adults, and evaluate potential risk factors contributing to failure of filtering surgery. A retrospective review was carried out of the charts of all glaucomatous patients between the age of 15 to 45 years. These patients had no history of previous extra- or intraocular surgery and had undergone primary trabeculectomy without the use of antimetabolites from January 1988 to January 1995 at the University Eye Hospital of Cologne. A total of 51 eyes of 45 patients fulfilled the inclusion criteria. There were no drop-outs from follow-up. Mean follow-up was 5.2 years (range, 2.5 to 9.5 years). Outcome was defined as a success when postoperative intraocular pressure (IOP) was 21 mm Hg or lower. If further glaucoma medication was required the outcome was described as a qualified success, and when the patient was free of medication the outcome was considered a complete success. Using the Kaplan-Meier survival curve, cumulative life-table success rates were 88% at 1 year (n = 51), 82% at 3 years (n = 47), 76% at 5 years (n = 26), and 70% at 7 years (n = 22). At final visit 71% (n = 36) were classified as successes, with 54% (n=30) being successful without adjunct medication. Seventeen percent (n = 6) required additional topical medication. Previous laser trabeculoplasty and an IOP greater than 40 mm Hg during the course of the disease was found to adversely affect the outcome. Eyes with iridocorneal epithelialopathy (ICE) syndrome, Rieger's anomaly, and uveitic glaucoma failed more frequently than those with juvenile, pigmentary, and primary open-angle glaucoma (POAG). Younger age (< 30 years) was not associated with a lower success rate after controlling for glaucoma category. The success rate of the uncomplicated group compares favorably with the 75% to 90% success rates of trabeculectomy commonly cited for primary glaucomas in older adults. Primary trabeculectomy in young patients may have a favorable outcome even without antimetabolite therapy.