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Graefe's Archive for Clinical and Experimental Ophthalmology

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01-04-2021 | Glaucoma | Glaucoma

Long-term follow-up of intraocular pressure and pressure-lowering medication in patients following Excimer laser trabeculotomy

Authors: C. Deubel, D. Böhringer, A. Anton, T. Reinhard, J. Lübke

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 4/2021

Abstract

Background

Excimer laser trabeculotomy (ELT) is a minimally invasive procedure to lower the intraocular pressure (IOP) via a photo-ablative laser that is applied to the trabecular meshwork. With this procedure, it is possible to improve the outflow of the aqueous humor. Until now, a limited number of studies examining mostly relatively small sample sizes with midterm follow-up exist. We therefore present the analysis of a large ELT cohort in a long-term follow-up.

Methods

We recorded data from 580 patients who underwent ELT or combined ELT with cataract surgery at our institution from November 2000 until March 2011. A total of 512 patients with primary open angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX), and ocular hypertension (OHT) were included in the analysis. At every follow-up examination, the usage of IOP-lowering medication and the IOP were recorded. Failure criteria were defined as the need for another surgical glaucoma procedure, when the IOP was not 21 mmHg or less and a reduction of 20% from the baseline was not achieved with (qualified success) or without (absolute success) additional medication. Statistical analysis was done using Kaplan-Meier analysis and Cox regression.

Results

Four hundred twenty-eight patients underwent combined cataract and ELT surgery, and 84 underwent solitary ELT surgery. After a median follow-up time of 656 days, 87% (combined surgery) and 66% (ELT) of the patients did not have to undergo another IOP-lowering intervention; 47/31% were classified as a qualified success and 31/11% as a complete success. The IOP-lowering medication, however, could not be significantly reduced within that time period.

Conclusion

Especially when combined with cataract surgery, ELT is a feasible minimally invasive procedure to lower the IOP on a mid- to long-term basis. Over the long term, however, IOP-lowering medication could not be reduced.

Avar M, Jordan JF, Neuburger M et al (2019) Long-term follow-up of intraocular pressure and pressure-lowering medication in patients after ab-interno trabeculectomy with the Trabectome. Graefes Arch Clin Exp Ophthalmol Albrecht Von Graefes Arch Klin Exp Ophthalmol 257:997–1003. https://doi.org/10.1007/s00417-019-04259-5CrossRef

Dietlein TS, Hermann MM, Jordan JF (2009) Medikamentöse und chirurgische Therapie des Glaukoms. Dtsch Arztebl Int 106:597–606PubMedPubMedCentral

Jonas JB, Aung T, Bourne RR et al (2017) Glaucoma. Lancet. https://doi.org/10.1016/S0140-6736(17)31469-1

Herdener S, Pache M (2007) Minimal-invasive Glaukomchirurgie: Excimer-Laser-Trabekulotomie. Ophthalmol 104:730–732. https://doi.org/10.1007/s00347-007-1598-6CrossRef

Carreon T, van der Merwe E, Fellman RL et al (2017) Aqueous outflow - a continuum from trabecular meshwork to episcleral veins. Prog Retin Eye Res 57:108–133. https://doi.org/10.1016/j.preteyeres.2016.12.004CrossRefPubMed

Töteberg-Harms M, Hanson JV, Funk J (2013) Cataract surgery combined with excimer laser trabeculotomy to lower intraocular pressure: effectiveness dependent on preoperative IOP. BMC Ophthalmol 13:24. https://doi.org/10.1186/1471-2415-13-24CrossRefPubMedPubMedCentral

Pache M, Wilmsmeyer S, Funk J (2006) Laser surgery for glaucoma: excimer-laser trabeculotomy. Klin Monatsbl Augenheilkd 223:303–307. https://doi.org/10.1055/s-2005-858861CrossRefPubMed

Babighian S, Caretti L, Tavolato M et al (2010) Excimer laser trabeculotomy vs 180 degrees selective laser trabeculoplasty in primary open-angle glaucoma. A 2-year randomized, controlled trial. Eye Lond Engl 24:632–638. https://doi.org/10.1038/eye.2009.172CrossRef

Shaarawy T, Grehn F, Sherwood M, World Glaucoma Association (2009) WGA guidelines on design and reporting of glaucoma surgical trials. Kugler Publ Amst

10.

R Core Team (2019) R: a language and environment for statistical computing. http://www.r-project.org.

11.

Töteberg-Harms M, Ciechanowski PP, Hirn C, Funk J (2011) One-year results after combined cataract surgery and excimer laser trabeculotomy for elevated intraocular pressure. Ophthalmol Z Dtsch Ophthalmol Ges 108:733–738. https://doi.org/10.1007/s00347-011-2337-6CrossRef

12.

Wilmsmeyer S, Philippin H, Funk J (2006) Excimer laser trabeculotomy: a new, minimally invasive procedure for patients with glaucoma. Graefes Arch Clin Exp Ophthalmol Albrecht Von Graefes Arch Klin Exp Ophthalmol 244:670–676. https://doi.org/10.1007/s00417-005-0136-yCrossRef

13.

Conlon R, Saheb H, Ahmed IIK (2017) Glaucoma treatment trends: a review. Can J Ophthalmol 52:114–124. https://doi.org/10.1016/j.jcjo.2016.07.013CrossRefPubMed

14.

Wecker T, Anton A, Neuburger M et al (2017) Trabeculotomy opening size and IOP reduction after Trabectome® surgery. Graefes Arch Clin Exp Ophthalmol 255:1643–1650. https://doi.org/10.1007/s00417-017-3683-0CrossRefPubMedPubMedCentral

15.

Jordan JF, Neuburger M, Reinhard T (2011) Minimal-invasive Kammerwinkelchirurgie: das Trabektom. Ophthalmochirurgie 23:167–171

Title: Long-term follow-up of intraocular pressure and pressure-lowering medication in patients following Excimer laser trabeculotomy
Authors: C. Deubel
D. Böhringer
A. Anton
T. Reinhard
J. Lübke
Publication date: 01-04-2021
Publisher: Springer Berlin Heidelberg
Keywords: Glaucoma
Trabeculotomy
Cataract
Laser
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 4/2021
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-020-05029-4

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Long-term follow-up of intraocular pressure and pressure-lowering medication in patients following Excimer laser trabeculotomy

Abstract

Background

Methods

Results

Conclusion

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