The outcomes of primary mixed glaucoma laser treatment

Fabrikantov O. L.
¹²

Yablokova N. V.
¹

Goydin A. P.
¹²

1 - The Academician S.N. Fyodorov FSАI IRTC «Eye Microsurgery» Tambov branch, Ministry of Public Health, Rasskazovskoe shosse, 1, Tambov, naukatmb@mail.ru
2 - FSBEI HPE «Tambov State University named after G.R. Derzhavin», Medical Institute, Inretnatsionalnaya str., 33, Tambov.

Purpose. To assess the outcomes of combined laser treatment in patients with primary mixed glaucoma. The study group included 26 patients (30 eyes) with primary mixed glaucoma and 1 month to 5 years follow-up. The mean follow-up was 30.30±2.90 months. Male – 16 (61.5%), female – 10 (38.5%). According to the stages, the patients were divided in the following way: stage I – 13 eyes (43.3%), stage II – 9 eyes (30%), stage III – 8 eyes (26.7%). The age varied from 63 to 84 years old (the mean age was 70.04±1.22 years). During the first stage all patients underwent laser iridectomy in the superior segment according to the standard method (at 10 to 2 o’clock) with a pulse energy 2.6-3.2 MJ and the number of pulses 3-9. The second stage included selective laser trabeculoplasty (SLT) by the standard method on the laser unit Selecta, the radiation source of which was a q-switched Nd:YAG laser of double frequency. The radiation wavelength – 532 nm, pulse duration 3 ns, single pulse energy 0.6 – 1.3 MJ, the light spot size was 400 microns. 50-60 pulses were applied to the trabecular area in the lower segment of the anterior chamber angle along the arc 180 degrees. The mean time between the stages was 2.58±0.51 months. The mean IOP values (P0) preoperatively (the first stage – laser iridectomy) were 20.67±0.69 mm Hg. The average number of hypotensive medications used prior to laser treatment was 2.12±0.13. The visual acuity before treatment was 0.733±0.044. The mean visual field (MD index) before treatment was 7.92±1.46 dB. After the first stage (laser iridectomy) and prior to the second one (SLT) IOP was 17.59±0.35 mm Hg. By the end of the follow-up (after laser iridectomy and SLT) the IOP level was 12.86±0.44 mm Hg. The average number of hypotensive medications during the last examination was 1.12±0.17. The mean visual field (MD index) before treatment was 7.92±1.46 dB, after treatment – 8.02±1.41 (the differences were not significant (enough Z=-0.17, p=0.861)). Visual acuity before treatment was 0.733±0.044, by the end of the follow-up – 0.621±0.055 (the differences were not significant (enough Z=-0.32, p=0.187)). When analyzing the hypotensive regimen the tendency towards its weakening was noted during the whole follow-up period. We managed to achieve the target IOP in 23 cases (76.7%). The repeated SLT was required in four patients in terms of 6 months to 1 year. Three patients were referred for hypotensive surgery in the period 1-3 years. The two-stage laser intervention in treating primary combined glaucoma allows achieving IOP normalization at the expense of the anterior chamber angle broadening with the following influence on the trabecula by means of selective trabeculoplasty in the majority of patients with different stages of the disease.

ophthalmology, primary mixed glaucoma, laser iridectomy, selective laser trabeculoplasty, intraocular pressure, anterior angle chamber, trabecular apparatus

10.29234/2308-9113-2017-5-4-64-72

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