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S. Wilmsmeyer, N. Feltgen, H. Philippin, J. Funk; Excimerlasertrabeculostomy, a New Minimally Invasive Glaucoma Surgery . Invest. Ophthalmol. Vis. Sci. 2005;46(13):76.
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Purpose: Excimerlasertrabeculostomy (ELT) is a new surgical technique to reduce intraocular pressure (IOP) in patients with glaucoma or ocular hypertension. Our purpose was to examine IOP–reduction and the use of antiglaucoma drugs (AGD) in patients treated with ELT, and to evaluate the safety of this laser treatment. Methods: To increase the outflow of aqueous humor, 10 microperforations of the trabecular meshwork were performed by an endoscope guided photoablative laser probe (Excimer laser, AIDA, TUI–Laser, Munich; pulse energy: 1.2 mJ at fiber tip, pulse duration: 60 ns, repetition rate: 20 Hz). Average operation time usually was 2 minutes. In our pilot study one group of patients without cataract underwent ELT, the other group with cataract phacoemulsification + ELT. The group with phacoemulsification + ELT was compared to patients with ocular hypertension or glaucoma who had cataract surgery only. IOP, visual acuity and AGD were determined preoperatively (T0) and 2–4 months (T1), 5–7 months (T2), 11–13 months (T3) and 22–26 months (T4) after surgery. Results: ELT alone reduced the IOP from 24.1±0.7 (n=69) mmHg preoperatively to 18.8±0.4 (T1, n=66), 20.0±0.5 (T2, n=51), 18.8±0.8 (T3, n= 37) and 16.8±1.0 (T4, n=15) mmHg respectively. The mean preoperative IOP of the one year follow–up group (n= 37) was 23.3±0.6 mmHg. The number of AGD was 1.9±0.1 (T0), 1.2±0.2 (T1), 1.3±0.2 (T2), 1.8±0.2 (T3) and 1.5±0.3 (T4). Combined phacoemulsification + ELT reduced the IOP from 22.4 ±0.6 (T0, n=57) mmHg to 16.5±0.4 (T1, n=52), 16.1±0.5 (T2, n= 40), 16.4±0.4 (T3, n= 35) and 12.8±1.5 (T4, n=4) mmHg respectively. The mean preoperative intraocular pressure of the one year follow–up group (n= 35) was 22.4±0.8 mmHg. The number of AGD was 1.1±0.2 (T0), 0.9±0.2 (T1), 1.1±0.2 (T2), 1.3±0.2 (T3) and 1.8±0.9 (T4). In eyes with phacoemulsification only IOP decreased from 20.8±0.2 (T0) mmHg to 18.1±0.6 (T2) and 18.3±0.6 (T3) mmHg . Conclusions: ELT, especially in combination with phacoemulsification, is a new promising minimally invasive laser treatment to reduce IOP for at least 1–2 years.
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