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S. Wilmsmeyer, H. Mueller, T. Ness, J. Funk; Excimer Laser Trabeculotomy: A New Minimal Invasive Procedure to Reduce Intraocular Pressure . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3305.
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Purpose: To evaluate the efficacy and safety of endoscopic excimer laser trabeculotomy (ELT) in combination with, or without cataract surgery in patients with ocular hypertension or glaucoma. Methods: We used a photoablative excimer laser (ELT=excimer laser trabeculotomy, AIDA, TUI-Laser Munich) to create microperforations in the trabecular meshwork. Altogether 41 eyes (n=41) of 37 patients were enrolled in our retrospective study (n=31 with ELT only, n=10 with ELT and cataract surgery). Visual acuity, intraocular pressure (IOP) and the number of antiglaucoma drugs were recorded preoperatively (t0) and postoperatively at t1 (2 - 6 weeks), t2 (6 weeks - 4 months) and t3 (>4 months). Ten matched eyes treated with trabeculectomy served as controls for the long term ELT eyes. Results: In ELT only, the mean intraocular pressure (IOP) was reduced from 25.3 mmHg to 20.2 mmHg (n=26)/ 19.3 mmHg (n=24)/ 19.0 mmHg (n=10, mean follow-up 7.5 months) at t1/t2/t3, respectively. In ELT combined with cataract surgery, the corresponding values were: preop. 23.5 mmHg, postop. 17.3 mmHg (n=8)/ 16.4 mmHg (n=8)/ 16.7 mmHg (n=3, mean follow-up 12.5 months) at t1/t2/t3, respectively. This represents an IOP decrease of 25% (ELT only) and 29% (ELT and cataract) at the final visit. The average number of antiglaucoma drugs was reduced from 1.9 to 0.8 / 1.0 / 1.2 (ELT only) and from 1.1 to 0.7 / 0.3/ 0.7 (ELT and cataract) at t1/t2/t3, respectively. Complications were rare: one patient had transient intraocular pressure spikes at day 1 postop., another patient needed additional surgery 2 months after the ELT because of persisting high IOP. The mean IOP in the control group treated with trabeculectomy was 28 mmHg preop. and 16 mmHg 9 months postop., i. e. IOP reduction was 43%. The number of antiglaucoma drugs was decreased from 2.2 to 0.5. However complications occurred more frequently: in 60% of the eyes a bleb leakage was observed, 20% had choroidal detachment, another 20% required postop. needle revision. Conclusions: The first results of patients treated with ELT are encouraging. This new method is less effective than trabeculectomy, but it is an outpatient procedure with very few complications. We believe it will become an established procedure in minimally invasive glaucoma surgery.
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