Titanium Sapphire Laser Trabeculoplasty: Hypotensive Efficacy and Anterior Chamber Inflammation

Abstract

Purpose:: To evaluate the efficacy and safety of titanium-sapphire laser trabeculoplasty for the treatment of primary open-angle glaucoma (POAG) in terms of hypotensive efficacy and anterior chamber inflammation.

Methods:: In a prospective non-randomized study 33 eyes of 33 consecutive patients with open-angle glaucoma were treated with a prototype titanium-saphire laser (790 nm). A total of approximately 50 spots (200 microns) were placed over inferior 180 degrees of the trabecular meshwork at energy levels ranging from 40 to 80 mJ. The IOP was measured 1 hour, 1 day, 1 week, and 1, 3, and 6 months postoperatively. Anterior chamber flare was measured using a laser flare meter (Kowa FM-500, Kowa Company Limited, Japan). During the follow-up period, patients were treated with topical antiglaucoma medications as required.

Results:: Mean age was 74 +/- 6.57 years old. Mean energy used was 50.7 +/- 8.5 mJ. The mean pretreatment IOP was 21.6 +/- 4.2 mm Hg. At 6 months of follow-up, the mean IOP reduction was 3.9 +/- 4.7 mm Hg or 15.4% (p=0.001). The percentage of responders (pressure decrease equal to or greater than 3 mmHg) at the end of follow up was 63.6% (21 of 33 eyes). Medical glaucomatous treatment was reduced from 1.5 +/- 0.7 to 0.9 +/- 0.7. One hour after laser trabeculoplasty, an increase in IOP of more than 5 mm Hg was detected in 7 eyes (21.2%). There were no other significant operative or postoperative complications. Mean preoperative flare was 15.8 +/- 7.9 photons/ms. We found a statistically significant increase in flare values only during the first 24 hours. One week after treatment no differences were found with respect to the baseline (p=0.437).

Conclusions:: Titanium-sapphire laser trabeculoplasty is an effective and safe treatment in patients with primary open-angle glaucoma.

Clinical Trial:: www.clinicaltrials.gov NCT00145535

Keywords: intraocular pressure • trabecular meshwork • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials