Selektive Lasertrabekuloplastik bei Patienten unter maximaler Lokaltherapie: Eine retrospektive Analyse

Background: Reduction of intraocular pressure (IOP) is still the mainstay of glaucoma treatment. Aim of this retrospective study was to analyse the efficacy of selective laser trabeculoplasty (SLT) in patients under maximum tolerated medical therapy. Special attention was paid to the question whether specific preoperative factors may influence the outcome of SLT. Material and methods: Inclusion criteria were patients with ocular hypertension or open angle glaucoma (primary open angle glaucoma, pseudoexfoliative glaucoma, pigmentary glaucoma, and normal tension glaucoma) who underwent SLT between 3/2008 and 12/2010 due to uncontrolled IOP despite maximum tolerated medical therapy, with a follow-up of at least 3 months. Data were collected preoperatively and then 1 day, 1 month and then 3-monthly after SLT up to a maximum follow-up of 2. 5 years. Main outcome measures were mean IOP reduction and success rates ( ³ 20 % IOP-reduction). Repeat SLT was not considered a failure. Results: One hundred and thirty-one eyes of 98 patients (58 female, mean age 71. 6 ± 11. 2 years, mean follow-up 1. 05 ± 0. 67 years) were included in the analysis. Mean IOP pre SLT was 19. 6 ± 4. 9 mmHg. Mean IOP was significantly reduced up to 1. 75 years after SLT (16. 6 ± 3. 6; p = 0. 044). Up to 2 years of follow-up, patients with higher baseline IOP had greater reduction of IOP (R ² = 0. 358; p = 0. 009). There was no significant difference in survival analysis for phakic vs. pseudophakic patients as well as for patients with vs. without Prostaglandins (p = 0. 671 and p = 0. 994, respectively). Twelve eyes had a repeated SLT (mean time to re-SLT 1. 03 ± 0. 55 years). Fifteen eyes had additional IOP lowering surgery (mean time to failure 0. 84 ± 0. 52 years). Conclusions: Even in patients on maximum IOP lowering medication SLT significantly reduces IOP for up to 1. 75 years, although the effect declines in magnitude over the time. IOP reduction is greater in patients with higher preoperative IOP.