Effect of Prior Cataract Surgery on the Clinical Outcome of Selective Laser Trabeculoplasty

PURPOSE: To compare the efficacy of selective laser trabeculoplasty (SLT) in phakic and pseudophakic eyes in primary open-angle glaucoma. METHODS: Charts of 55 phakic eyes and 24 pseudophakic eyes that underwent 360-degree SLT were retrospectively reviewed. Intraocular pressure (IOP) was measured before SLT and 1 week, 1, 3, 6, 9, 12, 18 and 24 months after SLT. Treatment success was defined as IOP reduction > or = 20% without additional medications, laser or glaucoma surgery. Mean IOP change, mean percentage of IOP reduction and success rates of phakic and pseudophakic eyes were compared. RESULTS: Mean percentage of IOP reduction after SLT at 1 week and 1, 3, 6, 9, 12, 18, and 24 months were 18.8%, 23.9%, 24.6%, 23.3%, 24.0%, 22.1%, 20.8%, and 17.9%, respectively, in the phakic group and 15.7%, 22.3%, 23.7%, 25.3%, 25.6%, 25.2%, 21.9%, and 19.3%, respectively, in the pseudophakic group. Success rates were 57.6 +/- 11.9% in the phakic group and 61.3 +/- 10.4% in the pseudophakic group. No statistically significant differences in IOP change, percentage of IOP reduction, and success rates were observed between the groups at each time point after SLT (p > 0.05). CONCLUSIONS: Application of 360-degree SLT appears an efficient treatment option for the management of phakic and pseudophakic open-angle glaucoma. Evaluating the success of SLT 1 month postoperatively may be premature.

Contralateral intraocular pressure lowering effect of prostaglandin analogues.

Background: Though the use of prostaglandin analogues (PGA) for reduction of intraocular pressure (IOP) has shown a marked increase, studies evaluating the contralateral eff ects of PGA are limited. Aims: To evaluate if PGA treatment in one eye has an eff ect on the IOP of the untreated fellow eye. Design: Retrospective study. Materials and Methods: Thirty patients of open-angle glaucoma with no previous antiglaucoma treatment underwent 24-hour diurnal IOP phasing. They subsequently were started on a uniocular trial with PGA, and had offi ce diurnal IOP measurements 6 weeks later. Twenty-four hour diurnal consisted of 8 IOP readings over 24 hours and offi ce diurnal consisted of 4 IOP readings between 8 AM and 6 PM at 3 hourly intervals. Statistical Analysis: IOPs of the fellow eye during the offi ce diurnal were compared with IOPs at similar time points during the 24-hour diurnal using paired t-tests. Results: Mean (± standard deviation) IOP in the treated eye reduced (P < 0.001) from 17.17 ± 3.2 mm Hg at baseline to 13.7 ± 2.4 mm Hg at 6 weeks, while that in the untreated eye reduced from 16.4 ± 3.1 mm Hg to 14.8 ± 2.7 mm Hg (P = 0.01). The decrease in IOP in the untreated fellow eye was statistically signifi cant at 8 AM (2.7 mm Hg, P = 0.003) and 11 AM (2.3 mm Hg, P = 0.01) but not so at 2 PM (1.2 mm Hg, P = 0.10) and 5 PM (0.9 mm Hg, P = 0.19). The amount of IOP reduction in the untreated eye was signifi cantly associated with the magnitude of IOP reduction in the treated eye (β = 0.69, P = 0.008). Conclusion: Uniocular PGA treatment tends to reduce the IOP of the untreated fellow eye.

Filtering Surgery in Aphakia and Pseudophakia

Aphakic or pseudophakic glau-oma is known to be at high risk for failure after filtration surgery. The authors retrospectively investigated the results of trabeculectomy in 14 eyes of 14 patients with glaucoma, seven aphakic and seven pseudophakic eyes, which were followed from six months to three years with an average ot 16.5 months. A conventional trabeculectomy without using antifibrotic agents was performed in all the eyes. The site of conjunctival incision was prepared on the virgin area of the conjunctiva; 8 superonasal, 4 inferonasal and 2 inferotemporal approaches. An average postoperative intraocular pressure reduction was 13.4 mmHg. The number of medications decreased in 11 eyes. A spontaneously developed functioning bleb was found in seven eyes. In other four eyes, the filtering bleb was formed with an aid of massage or needling. The remallllllg three eyes did not show a functioning bleb. Postoperative complications included hyphema in 3 eyes, overfiltration in 2 eyes, choroidal detachment in 1 eye, corneal edema in 1 eye and endophthalmitis in 1 eye.