Assuntos
Humanos , Humor Aquoso/metabolismo , Malha Trabecular/fisiopatologia , Malha Trabecular/metabolismo , Glaucoma/fisiopatologia , Glaucoma/metabolismo , Hipertensão Ocular/fisiopatologia , Matriz Extracelular/metabolismo , Pressão Intraocular/fisiologia , Malha Trabecular/cirurgia , Glaucoma/terapia , Implantes para Drenagem de GlaucomaRESUMO
OBJECTIVE: To evaluate the efficacy of selective laser trabeculoplasty (SLT) for the treatment of primary open-angle glaucoma in an African-derived population in the developing world. METHODS: Sixty-one subjects from St. Lucia with medically treated primary open-angle glaucoma underwent a 30-day washout, followed by bilateral 360° SLT. Intraocular pressure (IOP) was measured 1 hour; 1 week; and 1, 3, 6, 9, and 12 months after SLT. RESULTS: Mean (SD) IOP with medical therapy was 17.3 (5.0) mm Hg and 17.5 (4.0) mm Hg in the right and left eyes, respectively, and increased to 21.4 (3.6) mm Hg and 21.1 (3.5) mm Hg, respectively, after washout. Both eyes demonstrated a prompt and sustained IOP response to SLT therapy. Intraocular pressure dropped significantly by the first week and remained in the range of 13 to 14 mm Hg without medical therapy through 12 months in patients deemed successful. The mean IOP reductions from baseline ranged from 7.3 to 8.3 mm Hg (34.1%-38.8%) in right eyes and from 7.6 to 8.2 mm Hg (36.0%-38.9%) in left eyes through 12 months. The 12-month Kaplan-Meier survival rate (≥10% IOP reduction from postwashout baseline) was 77.7%, and 93% of successful subjects experienced IOP levels less than with-medication values. Most subjects reported moderate photophobia for 2 to 3 days after SLT; only 1 received anti-inflammatory therapy. Five eyes of 3 subjects had IOP spikes between 5 and 10 mm Hg that resolved without treatment. CONCLUSIONS: The magnitude and duration of IOP reduction are clinically relevant in individuals from St. Lucia of African descent. If repeatable, SLT could be a powerful tool for reducing glaucoma-related blindness in this population.
Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Terapia a Laser , Malha Trabecular/cirurgia , Trabeculectomia , População Negra/etnologia , Países em Desenvolvimento , Feminino , Glaucoma de Ângulo Aberto/etnologia , Glaucoma de Ângulo Aberto/fisiopatologia , Gonioscopia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Santa Lúcia/epidemiologia , Tonometria Ocular , Malha Trabecular/fisiopatologia , Resultado do Tratamento , Acuidade Visual/fisiologia , Campos Visuais/fisiologiaRESUMO
BACKGROUND AND OBJECTIVE: A novel computer-guided laser treatment for open-angle glaucoma, called patterned laser trabeculoplasty, and its preliminary clinical evaluation is described. PATIENTS AND METHODS: Forty-seven eyes of 25 patients with open-angle glaucoma received 532-nm laser treatment with 100-µm spots. Power was titrated for trabecular meshwork blanching at 10 ms and sub-visible treatment was applied with 5-ms pulses. The arc patterns of 66 spots rotated automatically after each laser application so that the new pattern was applied at an untreated position. RESULTS: Approximately 1,100 laser spots were placed per eye in 16 steps, covering 360° of trabecular meshwork. The intraocular pressure decreased from the pretreatment level of 21.9 ± 4.1 to 16.0 ± 2.3 mm Hg at 1 month (n = 41) and remained stable around 15.5 ± 2.7 mm Hg during 6 months of follow-up (n = 30). CONCLUSION: Patterned laser trabeculoplasty provides rapid, precise, and minimally traumatic (sub-visible) computer-guided treatment with exact abutment of the patterns, exhibiting a 24% reduction in intraocular pressure during 6 months of follow-up (P < .01).