Ефективність селективної лазерної трабекулопластики при первинній відкритокутовій глаукомі в залежності  від функціонального стану шлеміва каналу

N.G. Zavgorodnia; K. S. Sychova

doi:10.31288/oftalmolzh2024439

Authors

N.G. Zavgorodnia Zaporizhzhia State Medical and Pharmaceutical University, VISUS clinic, Zaporizhzhia (Ukraine)
K. S. Sychova Zaporizhzhia State Medical and Pharmaceutical University: Zaporizhzhia, UA https://orcid.org/0009-0003-2196-0211

DOI:

https://doi.org/10.31288/oftalmolzh2024439

Keywords:

primary open-angle glaucoma, intraocular pressure, selective laser trabeculoplasty, functional state of Schlemm’s canal

Abstract

Background: The European Glaucoma Society recommends that selective laser trabeculoplasty (SLT) be considered as a first-line treatment option for patients with mild or moderate primary open-angle glaucoma (POAG) or for those who have not responded well to medications.
Purpose: To assess the efficacy of POAG treatment with SLT based on examination of the function of Schlemm’s canal (SC)
Methods: This paper presents the results of clinical studies and one-month dynamic follow-up of 38 POAG patients (52 eyes) who underwent SLT with a Tango Reflex YAG/SLT laser (Ellex, USA) at the VISUS clinic (Zaporizhzia). Of the 38 patients, 18 (47.37%) were males and 20 (52.63%) females. Patient age ranged from 58 to 85 years (mean age ± standard deviation, 69 ± 9.9 years).
Results: There was a significant difference in the response to SLT between eyes with a functional blockage and those with an organic blockage of SC. In the former eyes, true intraocular pressure (P0) decreased from 25.66 ± 0.41 mmHg before SLT to 19.2 ± 0.24 mmHg, outflow facility coefficient increased by 40%, and Becker’s coefficient decreased by 46.63% at 1 month after SLT (p < 0.05). In eyes with an organic blockage of SC, P0 changed from 27.69 ± 0.51 mmHg before SLT to 27.64 ± 0.49 mmHg at 1 week, and even increased to 28.75 ± 0.52 mmHg at month 1 after SLT (p ˃ 0.05), and tonography characteristics did not change.
Conclusion: The current study demonstrated that the success rate of SLT in eyes with POAG was 69.2%. The success rate, however, may reach 100% (with a mean percentage IOP reduction of 25.18%, 40 percent increase in the outflow facility coefficient, and 46.63 percent decrease in the Becker’s coefficient) if SLT is performed only in POAG eyes with a functional blockage of SC. If established, the functional state of SC may be used for determining indications and contraindications for SLT in POAG.

Author Biographies

N.G. Zavgorodnia, Zaporizhzhia State Medical and Pharmaceutical University, VISUS clinic, Zaporizhzhia (Ukraine)

Dr Sc (Med), Prof.; Zaporizhzhia State Medical and Pharmaceutical University, Zaporizhzhia (Ukraine); VISUS clinic, Zaporizhzia

K. S. Sychova, Zaporizhzhia State Medical and Pharmaceutical University: Zaporizhzhia, UA

PhD Student, Department of Ophthalmology at Zaporizhzhia State Medical and Pharmaceutical University, Zaporizhzhia (Ukraine)

References

Reardon G, Kotak S, Schwartz GF. Objective Assessment of Compliance and Persistence among Patients Treated for Glaucoma and Ocular Hypertension: A Systematic Review. Patient Prefer Adherence. 2011; 5:441-63. https://doi.org/10.2147/PPA.S23780

European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition. Br J Ophthalmol. 2021 Jun;105(Suppl 1):1-169. https://doi.org/10.1136/bjophthalmol-2021-egsguidelines

Peretiagin OA, Dmytriiev SK, Lazar YuM, Tatarina YuA. Interrelationship of corneoscleral rigidity, corneal thickness and target IOP levels in patients with unstabilized POAG. J Ophthalmol (Ukraine). 2018;5:26-31. https://doi.org/10.31288/oftalmolzh201852631

Dmitriev SK, Peretiagin OA, Lazar YuM, Tatarina YuO. Relationships between target intraocular pressure and central corneal thickness in stabilized and non-stabilized glaucoma patients. 2021;2:10-5. https://doi.org/10.31288/oftalmolzh202121015

Gazzard G, Konstantakopoulou E, Garway- Heath D, et al. Selective laser trabeculoplasty versus drops for newly diagnosed ocular hypertension and glaucoma: the LiGHT RCT. Health Technol Asses. 2019; 23(31):1-102. https://doi.org/10.3310/hta23310

Goldenfeld M, Belkin M, Dobkin-Bekman M, Sacks Z, Blum Meirovitch S, Geffen N, et al. Automated Direct Selective Laser Trabeculoplasty: First Prospective Clinical Trial. Transl Vis Sci Technol. 2021;10(3):5. https://doi.org/10.1167/tvst.10.3.5

Novytskyy I, Rudavska LM. [Non-penetrating deep sclerectomy with diode laser trabeculoplasty ab externo in patients with open-angle glaucoma]. Oftalmol Zh. 2013;1:21-4. Ukrainian.

Gračner T. Comparative Study of the Efficacy of Selective Laser Trabeculoplasty as Initial or Adjunctive Treatment for Primary Open-Angle Glaucoma. Eur J Ophthalmol. 2019; 29:524-31. https://doi.org/10.1177/1120672118801129

Weinand FS, Althen F. Long-Term Clinical Results of Selective Laser Trabeculoplasty in the Treatment of Primary Open Angle Glaucoma. Eur J Ophthalmol. 2006; 16:100-4. https://doi.org/10.1177/112067210601600116

Zhang H, Yang Y, Xu J, Yu M. Selective Laser Trabeculoplasty in Treating Post-Trabeculectomy Advanced Primary Open-Angle Glaucoma. Experimental and Therapeutic Medicine. 2016; 11:1090-4. https://doi.org/10.3892/etm.2015.2959

Garg A, Vickerstaff V, Nathwani N, Garway-Heath D, Konstantakopoulou E, Ambler G, et al. Laser in Glaucoma and Ocular Hypertension Trial Study Group. Primary Selective Laser Trabeculoplasty for Open-Angle Glaucoma and Ocular Hypertension: Clinical Outcomes, Predictors of Success, and Safety from the Laser in Glaucoma and Ocular Hypertension Trial. Ophthalmology. 2019 Sep;126(9):1238-1248. https://doi.org/10.1016/j.ophtha.2019.04.012

Hirn C, Zehnder S, Bauer G, Jaggi GP, Töteberg-Harms M, Zweifel SA, et al. Long-term efficacy of selective laser trabeculoplasty in patients on prostaglandin therapy. Klin Monbl Augenheilkd. 2014;231(4):351-6. https://doi.org/10.1055/s-0034-1368218

Katz LJ, Steinmann WC, Kabir A, Molineaux J, Wizov SS, Marcellino G, et al. Selective laser trabeculoplasty versus medical therapy as initial treatment of glaucoma: A prospective, randomized trial. J Glaucoma. 2012;21:460-8. https://doi.org/10.1097/IJG.0b013e318218287f

Xu L, Yu RJ, Ding XM, Li M, Wu Y, Zhu L, Chen D, Peng C, Zeng CJ, Guo WY. Efficacy of low-energy selective laser trabeculoplasty on the treatment of primary open angle glaucoma. Int J Ophthalmol. 2019 Sep 18;12(9):1432-1437. https://doi.org/10.18240/ijo.2019.09.10

Ayala M. Intraocular pressure reduction after initial failure of selective laser trabeculoplasty (SLT). Graefe's Archive Clin Exp Ophthalmol. 2014;252:315-20. https://doi.org/10.1007/s00417-013-2522-1

Greninger DA, Lowry EA, Porco TC, Naseri A, Stamper RL, Han Y. Resident-performed selective laser trabeculoplasty in patients with open-angle glaucoma. JAMA Ophthalmology. 2014;132:403-8. https://doi.org/10.1001/jamaophthalmol.2013.7651

Abdelrahman AM, Eltanamly RM. Selective laser trabeculoplasty in Egyptian patients with primary open-angle glaucoma. Middle East Afr J Ophthalmol. 2012;19:299-303. https://doi.org/10.4103/0974-9233.97930

Tang M, Fu Y, Fu MS, Fan Y, Zou HD, Sun XD, Xu X. The efficacy of low-energy selective laser trabeculoplasty. Ophthalmic Surg Lasers Imaging. 2011;42(1):59-63. https://doi.org/10.3928/15428877-20101124-07

Zavgorodnia NG, Pasyechnikova NV. [Primary glaucoma: A new look at an old problem]. Zaporizhzhia-Odesa: Orbita-YUG; 2008. Ukrainian.