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Neerav Lamba, Hercules Logothetis, Thomas Patrianakos, Erik Anderson, Glaucoma Laser Efficacy; Effects of Laser Suture Lysis on the Success of Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3161.
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© ARVO (1962-2015); The Authors (2016-present)
To compare intraocular pressure (IOP) results and medication use of standard trabeculectomy with antifibrotics (TrabMMC) with TrabMMC who received additional laser suture lysis (TrabMMC/LSL) post-operatively.
60 eyes with open angle glaucoma who received either TrabMMC (30 eyes) or a TrabMMC/LSL (30 eyes) were retrospectively reviewed. All trabeculectomies performed were fornix based. Success was defined as IOP of > 5 mmHg and < 21 mmHg and/or a reduction in IOP (from the preoperative level) of greater than 30% with or without medications.
The mean age was 66.4 and 68.2 years in the TrabMMC and TrabMMC/LSL groups, respectively. The mean preoperative IOP was 26.40 mmHg and 26.07 mmHg for the TrabMMC and TrabMMC/LSL group. Postoperative mean IOP at 1, 6, and 12 month intervals for the TrabMMC group was 16.70, 14.73, 16.53mmHg and for the TrabMMC/LSL group was 17.97,13.80, 15.00 mmHg. Mean number of days that LSL was performed post-operatively was 14.2. Standard deviation at 12 months was 6.04 mmHg for TrabMMC and 5.97mmHg for TrabMMC/LSL. Success at 12 months was 63.33 % for TrabMMC and 53.33% for TrabMMC/LSL. Mean number of ocular hypotensive medications decreased from 3.87 to 1.8 in the TrabMMC and 3.5 to 2.1 in the TrabMMC/LSL group at 12 months.
The success of TrabMMC is dependent on postoperative flow regulation into the filtering bleb. Our study demonstrates that LSL following TrabMMC in the early postoperative period can play an effective and safe role in the titratation of filtration. At 12 months, there was no statistically significant difference in success rates and number of medications pre and post operatively between the TrabMMC and TrabMMC/LSL. Although laser suture lysis is not an entirely innocuous procedure, with appropriate follow up and management, the IOP outcomes at 12 months are similar between the TrabMMC and TrabMMC/LSL groups.
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