Modern possibilities of laser surgery in the treatment of primary open-angle pigmentary glaucoma

Abstract

PURPOSE. To analyze the effectiveness of the complex method of pigmentary glaucoma laser surgery: YAG-laser iridectomy and multistep selective laser trabeculoplasty (SLT).METHODS. We examined 18 patients (36 eyes) between 13 and 54 years old with primary open-angle pigmentary glaucoma: initial stage was detected in 13 patients (26 eyes), moderate stage — in 4 patients (8 eyes), advanced stage — in 1 patient (2 eyes). Laser iridectomy was performed as the first stage after individual IOP level was reached by drug therapy. SLT was performed 4 weeks later and was repeated around the trabecula every 4–6 months if exogenous pigmentation exceeded grade II. The observation period lasted 4 to 15 years.RESULTS. The glaucoma process was stabilized successfully in all cases. True IOP decreased by 6.6±0.3 mm Hg (-30%, p<0.05), Becker’s coefficient — by 121±4.3 (-60%, p<0.001), the number of drug instillations — by 1.32±0.06 (-70%, p<0.001). The following indicators increased: mean total retinal photosensitivity — by 381±4.3 dB (15%, p<0.001), mean threshold of retinal photosensitivity — by 2.6±0.1 dB (10%, p<0.001), ease of intraocular liquid outflow — by 0.08±0.013 (72%, p<0.001). Hypotensive drug therapy was canceled in 15 cases (41.7%).CONCLUSION. Laser surgery of pigmentary glaucoma consisting of YAG-laser iridectomy combined with multistep SLT is an effective and safe method. It can be performed if the elevated IOP is normalized to the individual norm by drug therapy.