Selective laser trabeculoplasty for primary angle closure with persistently elevated intraocular pressure after iridotomy.

PURPOSE: To determine whether selective laser trabeculoplasty (SLT) can lower intraocular pressure (IOP) in eyes with chronic primary angle closure, elevated IOP, and a patent iridotomy. PATIENTS AND METHODS: Patients with chronic angle closure who had underwent iridotomy, had an IOP greater than 21 mm Hg and a gonioscopically visible pigmented trabecular meshwork for at least 90 degrees were enrolled. SLT was applied to open angle segments. Duration of follow-up was 6 months. RESULTS: Sixty eyes of 60 patients were enrolled. The mean baseline IOP was 24.6+/-2.5 mm Hg. At 6 months, IOP reduction of > or =3 mm Hg or 4 mm Hg was measured in 82% and 72% of eyes, respectively, and IOP reduction of > or =20% or 30% was measured in 54% and 24% of eyes, respectively. When only eyes that were treated with the same number or fewer medications were considered, these IOP reductions were measured in 67%, 58%, 43%, and 15%, respectively. During the study period 1 eye (1.7%) required trabeculectomy owing to IOP elevation shortly after the SLT. There were no other significant complications attributable to SLT. CONCLUSIONS: SLT seems to be a safe and effective method of reducing IOP in many eyes with primary angle closure and a patent iridotomy in which there is a sufficient extent of visible trabecular meshwork.

Comparison of outcomes of trabeculectomies using 0.4 mg/ml versus 0.2 mg/ml concentrations of mitomycin-C

Methods: A prospective, randomized, comparative study was performed involving patients undergoing trabeculectomy who were randomly assigned to either 0.2 mg/ml MMC for 4 minutes or 0.4 mg/ml for 2 minutes. The IOP, bleb characteristics, and occurrence of complications were compared. Age and gender of the patients, preoperative IOP, MMC concentration, bleb characteristics, angle status, and age of the surgery were analyzed to determine if they are predictive factors of the postoperative IOP using univariate and multivariate analyses. Results Seventy-four eyes of 68 patients underwent trabeculectomy: 36 eyes were treated with 0.2 mg/ml MMC for 4 minutes and 38 eyes with 0.4 mg/ml MMC for 2 minutes. There was no statistically significant difference in the mean preoperative IOP and postoperative IOP, as well as in the mean percent change in IOP (p = 0.87) between the 2 groups. Univariate and multivariate analyses showed the preoperative IOP (p = 0.02) and the type of filtering bleb (cystic p < 0.001; diffuse p = 0.045) as predictive factors of postoperative IOP. KaplanMeier survival curves showed no significant difference between the 2 groups at an average follow-up of 20 weeks. Conclusion: There is no significant difference in the outcomes of trabeculectomies using 0.2 mg/ml and 0.4 mg/ml MMC. Preoperative IOP and bleb characteristics are factors predictive of successful filtration surgery.

Latanoprost in the management of angle closure glaucoma

Objective: To investigate the effect of latanoprost in IOP after laser iridectomy or filtering surgery Methodology: Patients of chronic angle closure glaucoma post laser iridectomy or filtering surgery were given latanoprost 0.005 percent eye drop in the evening for 2-6 weeks after a washout period ranging from 5 days - 28 days. IOP was measured at 9:00 a. m., 1:00 p.m. and 5: 00 p.m. per patient using a calibrated goldmann applanation tonometer Results: 29 patients were enrolled in study. There was a significant reduction in IOP among these patients Conclusion: Latanoprost 0.005 percent provides a significant reduction in IOP among patients with residual angle closure after laser iridectomy or filtering surgery. (Author)