Die Grenzen der selektiven Lasertrabekuloplastik zur Behandlung des Glaukoms

Zusammenfassung

Einleitung: Ziel dieser Studie ist es, den Stellenwert der selektiven Lasertrabekuloplastik (SLT) in einer Klinik der Tertiärversorgung darzustellen.

Material und Methoden: Wir führten eine retrospektive Datenanalyse von Patienten, die an der Universitätsaugenklinik Hamburg Eppendorf behandelt wurden, durch. 113 Augen von 113 Patienten mit primär chronischem Offenwinkelglaukom, die zwischen 03/2011 und 01/2014 eine SLT-Therapie bekamen und ein Follow-up von mindestens 4 Monate aufwiesen, wurden eingeschlossen.

Ergebnisse: Es zeigte sich eine mittlere Drucksenkung von 1,08 mmHg oder 7 % im Zeitraum von 4 bis 6 Monaten nach der Behandlung. Bei 43,7 % der Augen war innerhalb von 12 Monaten eine weitere drucksenkende Maßnahme (Intensivierung der topischen drucksenkenden Therapie oder drucksenkender Eingriff) erforderlich.

Diskussion: Wir stellten fest, dass bei einem konservativ oder operativ vorbehandelten Patientenkollektiv mit niedrigem Ausgangsdruck und niedrigem Zieldruck durch eine alleinige SLT keine hinreichende und dauerhafte Drucksenkung zu erzielen war.

Abstract

Introduction: The aim of this study was to evaluate the efficacy of selective laser trabeculoplasty (SLT) in the University Eye Hospital Hamburg Eppendorf.

Material and Methods: We conducted a retrospective analysis of 113 eyes of 113 consecutively treated patients who underwent SLT treatment between 03/2011 and 01/2014 and had a follow-up of at least 4 months.

Results: Intraocular pressure was reduced by 1.08 mmHg (7 % reduction) on average. In 43.7 % of the treated eyes, additional medical or surgical glaucoma treatment was necessary within 12 months.

Conclusion: SLT is not effective as monotherapy in pre-treated eyes with low target pressure.

Schlüsselwörter

Therapie - selektive Lasertrabekuloplastik - Glaukom

Key words

selective laser trabeculoplasty - glaucoma - therapy

• Literatur

• 1 Bourne RR, Jonas JB, Flaxman SR. et al. Prevalence and causes of vision loss in high-income countries and in Eastern and Central Europe: 1990–2010. Br J Ophthalmol 2014; 98: 629-638
• 2 Gordon MO, Beiser JA, Brandt JD. et al. The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol 2002; 120: 714-720
• 3 Sihota R. Lasers in primary open angle glaucoma. Indian J Ophthalmol 2011; 59 (Suppl. 01) S14-S17
• 4 Latina MA, Tumbocon JA. Selective laser trabeculoplasty: a new treatment option for open angle glaucoma. Curr Opin Ophthalmol 2002; 13: 94-96
• 5 Latina MA, Sibayan SA, Shin DH. et al. Q-switched 532-nm Nd : YAG laser trabeculoplasty (selective laser trabeculoplasty): a multicenter, pilot, clinical study. Ophthalmology 1998; 105: 2082-2088
• 6 Latina MA, Park C. Selective targeting of trabecular meshwork cells: in vitro studies of pulsed and CW laser interactions. Exp Eye Res 1995; 60: 359-371
• 7 Shazly TA, Latina MA. Intraocular pressure response to selective laser trabeculoplasty in the first treated eye vs. the fellow eye. Arch Ophthalmol 2011; 129: 699-702
• 8 Katz LJ, Steinmann WC, Kabir A. et al. Selective laser trabeculoplasty versus medical therapy as initial treatment of glaucoma: a prospective, randomized trial. J Glaucoma 2012; 21: 460-468
• 9 Meyer JJ, Lawrence SD. Whatʼs new in laser treatment for glaucoma?. Curr Opin Ophthalmol 2012; 23: 111-117
• 10 Gracner T, Naji M, Hudovernik M. et al. [Predictive factors of successful selective laser trabeculoplasty in open-angle glaucoma]. Klin Monatsbl Augenheilkd 2007; 224: 922-926
• 11 Melamed S, Ben Simon GJ, Levkovitch-Verbin H. Selective Laser trabeculoplasty as primary treatment for open-angle glaucoma: a prospective, nonrandomized pilot study. Arch Ophthalmol 2003; 121: 957-960
• 12 Gracner T. Intraocular pressure reduction after selective laser trabeculoplasty in primary open angle glaucoma. Coll Antropol 2001; 25 (Suppl. 01) S11-S115
• 13 Alvarado JA. Selective laser trabeculoplasty: underlying mechanism. Ophthalmol Management 2002; 1 Online: http://www.ophthalmologymanagement.com/articleviewer.aspx?articleid=85499. Stand: 01.08.2016
• 14 Kramer TR, Noecker RJ. Comparison of the morphologic changes after selective laser trabeculoplasty and argon laser trabeculoplasty in human eye bank eyes. Ophthalmology 2001; 108: 773-779
• 15 Van der Zypen E, Fankhauser F, England C. et al. Morphology of the trabecular meshwork within monkey (Macaca speciosa) eyes after irradiation with the free-running Nd : YAG laser. Ophthalmology 1987; 94: 171-179
• 16 Guzey M, Vural H, Satici A. et al. Increase of free oxygen radicals in aqueous humour induced by selective Nd : YAG laser trabeculoplasty in the rabbit. Eur J Ophthalmol 2001; 11: 47-52
• 17 Damji KF, Shah KC, Rock WJ. et al. Selective laser trabeculoplasty v argon laser trabeculoplasty: a prospective randomised clinical trial. Br J Ophthalmol 1999; 83: 718-722
• 18 Damji KF, Bovell AM, Hodge WG. et al. Selective laser trabeculoplasty versus argon laser trabeculoplasty: results from a 1-year randomised clinical trial. Br J Ophthalmol 2006; 90: 1490-1494
• 19 Ayala M, Chen E. Predictive factors of success in selective laser trabeculoplasty (SLT) treatment. Clin Ophthalmol 2011; 5: 573-576
• 20 Song J, Lee PP, Epstein DL. et al. High failure rate associated with 180 degrees selective laser trabeculoplasty. J Glaucoma 2005; 14: 400-408
• 21 Mao AJ, Pan XJ, McIlraith I. et al. Development of a prediction rule to estimate the probability of acceptable intraocular pressure reduction after selective laser trabeculoplasty in open-angle glaucoma and ocular hypertension. J Glaucoma 2008; 17: 449-454
• 22 George MK, Emerson JW, Cheema SA. et al. Evaluation of a modified protocol for selective laser trabeculoplasty. J Glaucoma 2008; 17: 197-202
• 23 Johnson PB, Katz LJ, Rhee DJ. Selective laser trabeculoplasty: predictive value of early intraocular pressure measurements for success at 3 months. Br J Ophthalmol 2006; 90: 741-743