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S.R. Babighian, M. Tavolato, A. Galan; Comparison of Excimer Laser Trabeculotomy (ELT) versus Selective Laser Trabeculoplasty (SLT) in the Treatment of Primary Open–Angle Glaucoma. 18 Months of Follow–Up . Invest. Ophthalmol. Vis. Sci. 2006;47(13):20.
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To compare the safety and clinical efficacy of excimer laser trabeculotomy (ELT) versus selective laser trabeculoplasty (SLT) in patients with medically uncontrolled primary open angle glaucoma (POAG).
Thirty eyes of thirty patients with POAG refractory to medical therapy were randomized to treatment with ELT (Excimer Laser AIDA, Glautec AG, Nürnberg, Germany) or SLT (Trabeculas A.R.C. Laser GmbH, Germany). Before and at 1 day, 1 week, 1, 3, 6, 9, 12 and 18 months after the treatment, all subjects underwent visual acuity evaluation, IOP measurement, slitlamp examination, ophthalmoscopy and gonioscopy. Intra– and postoperative complications were analysed. Postoperative success was defined on the basis of a IOP lowering to 20% or more, compared to baseline IOP values, without additional glaucoma medical, laser or surgical therapy. The percentage of treatment success rate was calculated using the Kaplan–Meyer life–table method.
The mean ± SD follow–up time was 19.5 ± 1.2 months for ELT and 18.5 ± 0.5 months for SLT. At the last follow–up the success rate was 86.7% in the ELT group (from 26.2 ± 3.2 mmHg to 17.1 ± 3.4 mmHg; –34.7%, P<0.0001) and 73.3% for SLT group (from 24.2 ± 2.2 mmHg to 18.1 ± 1.0 mmHg; –25.2%, P<0.0001). The mean ± SD number of IOP–lowering medications was reduced from 2.27 ± 0.6 preoperatively to 0.73 ± 0.8 at the last follow–up in the ELT group and from 2.20 ± 0.7 to 0.87 ± 0.8 in the SLT group. No remarkable intra–or postoperative complications were noted in SLT group. In 80% of eyes submitted to ELT intraoperative blood reflux occurred and spontaneously resolved within 5 days, without functional consequences. No change in visual acuity was observed in both groups.
Although endowed with a different mechanism of action, over 18 months of follow up both ELT and SLT showed a marked statistically significant IOP–lowering effect compared to the baseline values even if with a different trend during the follow–up. Both the techniques are repeatable, quick and relatively safe and may prove useful for those patients in whom surgery is undesirable because of a high risk of surgical complications or in patients who cannot tolerate or are noncompliant with their glaucoma medications.
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