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L. Ogunbowale, A. Spratt, N. Anand, W. Franks; Paradoxical Intraocular Pressure (IOP) Rise With Titanium Sapphire Selective Laser Trabeculoplasty (TiSaLT). Invest. Ophthalmol. Vis. Sci. 2007;48(13):3974.
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Nd:YAG Selective laser trabeculoplasty (SLT) has been reported to reduce IOP. To report the treatment results of patients receiving TiSaLT.
We used TiSaLT at 780nm wavelength to treat raised IOP in eyes with ocular hypertension (OHT), primary open angle glaucoma (POAG), glaucoma complicating pigment dispersion syndrome (PDS) and pseudoexfoliation (PXE) inadequately controlled with, or intolerant of, medical treatment.
Two UK centers treated 67 eyes of 44 patients. Twenty five were women, mean age [range] was 64 [27-85] years. Seven eyes had PDS, three PXE, nine OHT and 48 POAG. Mean follow-up was 42 [4-91] weeks. Mean number of pre-treatment medicines was 2.1 and post-treatment 1.8 (t-test: p=0.043). Mean pre-treatment IOP was 23.1mmHg [15-34] and final post-treatment IOP was 20.0mmHg [5-40]. Nineteen eyes had an immediate IOP fall, five achieving a satisfactory target pressure. Forty eight eyes had an IOP rise within four weeks of treatment: 1-5mmHg in 21 eyes, 6-10 mmHg in 16 eyes, 11-20mmHg in 5 eyes and >21 mmHg in 6 eyes. This initial IOP rise settled in 21 eyes without additional medication. Five eyes had repeat TiSaLT without success; 12 eyes needed trabeculectomy surgery within 60 weeks of treatment (mean 36 weeks [4-60]). IOP of the 10 eyes with PDS and PXE rose by a mean of 7mmHg [-9 to +19].
The IOP outcomes of TiSaLT were inferior to those of frequency-doubled Nd:YAG SLT. TiSaLT was also associated with a significant risk of acute IOPrise.
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