[Microinvasive glaucoma surgery-Efficacy of trabecular stents in combined interventions : A clinical study on 65 eyes]. / Mikroinvasive Glaukomchirurgie ­ Wirksamkeit von trabekulären Stents bei kombinierten Eingriffen : Eine klinische Studie an 65 Augen.

BACKGROUND AND OBJECTIVE: In this prospective randomized simple blind study, we investigated the long-term results of trabecular micro-bypass stent implantation as part of routine cataract surgery in eyes with primary chronic open-angle glaucoma. The chamber angle implants drain between the anterior chamber and the canal of Schlemm and circumvent the main outflow resistance by the trabecular meshwork. PATIENTS AND METHODS: The study included 65 eyes from 56 patients with primary chronic open-angle glaucoma with at least 2 different pressure-lowering drugs. Patients with low-tension glaucoma, secondary glaucoma and ocular hypertension were excluded. Of the 65 eyes 31 underwent a combined cataract surgery with subsequent implantation of 2 iStents inject GTS-400 (Glaukos Corporation, San Clemente, CA, USA) into the canal of Schlemm. In the same time period 34 of the 65 eyes underwent standard cataract surgery without stent implantation. RESULTS: The longest follow-up time was 38 months and the mean follow-up time was 14 months. In our follow-up observational study the average intraocular pressure (IOP) reduction with combined surgery was 5.9 mm Hg or 23.5% of the original value (p < 0.001). The extent of IOP reduction depended on the level of the preoperative pressure. CONCLUSION: The combined phacoemulsification and trabecular micro-bypass implantation was shown to be an effective and safe treatment method for reduction of IOP and the burden of local administration of medication could be reduced. The implantation provides a good option for additional reduction of IOP. Our results showed a favorable risk-benefit profile. Further long-term in vivo studies are needed to determine the long-term safety and efficacy.

[Pressure reduction after selective laser trabeculoplasty with two different laser systems and after argon laser trabeculoplasty--a controlled prospective clinical trial on 284 eyes]. / Augendrucksenkung nach selektiver Lasertrabekuloplastik (SLT) mit zwei unterschiedlichen Lasersystemen und nach Argonlasertrabekuloplastik (ALT)--Eine kontrollierte prospektive klinische Studie an 284 Augen.

BACKGROUND: Selective laser trabeculoplasty (SLT) is a new method to reduce intraocular pressure in eyes with primary open angle glaucoma. The laser parameters of a Q-switched, frequency-doubled Nd:YAG-laser are set to selectively target pigmented trabecular meshwork cells without visible damage to the adjacent non-pigmented tissue. SLT acts non-thermally, the intracellular microdisruptions triggered by the laser are confined to the targeted cells, the laser pulses are so short that heat caused within the targeted cells does not have time to spread to the surrounding tissue. A controlled prospective randomised clinical study was conducted to compare the long-term results, safety and efficacy after SLT with two different laser systems and after ALT in the treatment of ocular hypertension and medically uncontrolled open angle glaucoma. PATIENTS AND METHODS: About two years ago the authors performed a selective laser trabeculoplasty in 119 eyes using the SLT laser unit Otello (Glautec AG, ARC, EC), here named as SLT-I, and in 124 eyes using the SLT laser unit Selecta II (Lumenis, Palo Alto, CA), here named as SLT-II. In 41 eyes the authors performed argon laser trabeculoplasties using the argon laser Argus (Aesculap Meditec, EC). RESULTS: Two months after treatment mean IOP reduction from baseline was 1.9 mmHg or, respectively, 8.8 % after SLT with the SLT-System I, 2.0 mmHg or, respectively, 9.5 % after SLT with SLT-System II, and 2.2 mmHg or, respectively, 9.9 % after ALT with the argon laser. Twelve months after LTP mean pressure reductions were 1.7 mmHg (7.9 %) after SLT-I, 1.8 mmHg (8.5 %) after SLT-II, and 2.1 mmHg (9.4 %) after ALT. The response curve of the eyes with SLT-I greatly resembled that of the eyes with SLT-II and those eyes with ALT. CONCLUSIONS: Pressure reduction was highest after ALT, followed by SLT-II, in SLT-I reduction was the least, but the differences were not significant. Our findings did not correspond with those of other authors reporting an average IOP reduction of 25 % after SLT and ALT. SLT has shown reasonable efficacy in lowering IOP in eyes with ocular hypertension and primary open angle glaucoma, SLT achieves about the same level of IOP reduction compared with ALT. As a result of the preservation of the structure of the trabecular meshwork and low rate of complications, SLT is a safe alternative to ALT. The exact biological effect induced with SLT is still not yet understood. For the early glaucoma stages SLT provides an alternative to drug treatment, for the advanced glaucomas SLT is an additional option for further pressure reduction. More long-term follow-up studies are needed to determine whether the IOP lowering effect is sustained over time, and to assess the efficacy of repeated SLT.

[Long-term results after selective laser trabeculoplasty -- a clinical study on 269 eyes]. / Langzeitergebnisse nach selektiver Lasertrabekuloplastik -- eine klinische Studie an 269 Augen.

BACKGROUND: Selective laser trabeculoplasty SLT is a new method to reduce intraocular pressure in eyes with primary open angle glaucoma. With a Q-switched, frequency-doubled Nd:YAG laser it targets the pigmented trabecular meshwork cells without visible damage to the adjacent non-pigmented tissue. SLT acts non-thermally, the intracellular microdisruptions triggered by the laser are confined to the targeted cells, the laser pulses are so short that heat created within the targeted cells does not have time to spread to the surrounding tissue. A clinical prospective study was conducted to evaluate the long-term results, safety and efficacy of SLT in the treatment of open angle glaucoma. PATIENTS AND METHODS: Since 2002, we have performed a selective laser trabeculoplasty in 269 eyes: in 17 eyes with ocular hypertension, in 239 eyes with primary open angle glaucoma, in 11 eyes with low tension glaucoma, while 2 eyes had a secondary glaucoma due to uveitis. In 22 eyes the primary initial treatment was SLT. RESULTS: Three months after treatment, the mean IOP reduction from baseline was 3.4 mm Hg, respectively 15 %, after 12 months the mean IOP reduction was 3.0 mm Hg (12.9 %), and after 24 months 2.7 mm Hg or 12.1 %. The response curve of the eyes with ocular hypertension greatly resembled the eyes with primary open angle glaucoma and with low tension glaucoma. CONCLUSIONS: SLT has shown reasonable efficacy in lowering IOP in eyes with primary open angle glaucoma and ocular hypertension, both as a first-line treatment and as a treatment in medication-refractory eyes. SLT is effective for patients who have had prior treatment with ALT. Long-term follow-up studies are needed to determine whether the IOP lowering effect is sustained over time, and to assess the efficacy of repeated SLT. The exact biological effect induced with the SLT is still not understood.