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Previous laser trabeculoplasty may affect new minimally invasive procedure results
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 Steven D. Vold |
Previous laser trabeculoplasty was associated with slightly increased need for medication in patients undergoing the trabeculectomy ab interno treatment for open-angle glaucoma, a large study found.
Investigators studied the impact of previous laser trabeculoplasty on clinical outcomes in patients undergoing the Trabectome procedure (NeoMedix). Patients with or without previous laser surgery underwent Trabectome alone or combined with phacoemulsification.
“In most patients, previous laser trabeculoplasty does not appear to significantly impact the postoperative intraocular pressure following Trabectome surgery,” Steven D. Vold, MD, the lead author, told Ocular Surgery News in an e-mail interview. “Phakic patients who have undergone previous laser trabeculoplasty appear to need slightly more medication following the Trabectome procedure alone.”
Dr. Vold and fellow members of the Trabectome Study Group published their findings in Ophthalmic Surgery, Lasers & Imaging in July.
Methods, measures and outcomes
The retrospective study included 852 patients who underwent Trabectome without previous laser trabeculoplasty and 493 patients who underwent Trabectome with previous laser trabeculoplasty.
The group with no previous laser surgery included 586 phakic patients and 214 pseudophakic patients; lens status was not reported for 52 patients. The group included 344 patients who underwent Trabectome combined with phacoemulsification and 508 patients who underwent Trabectome only. The previous-laser surgery group included 349 phakic patients and 130 pseudophakic patients; lens status was not available for 14 patients. The group comprised 159 patients who underwent combined Trabectome and phacoemulsification and 334 patients who had Trabectome only.
In combined cases, surgeons normally undertook phacoemulsification after completing the Trabectome procedure.
Patients were followed for 36 months. Primary outcome measures were IOP, number of glaucoma medications used and the need for secondary procedures to be performed.
Study results showed that eyes with previous laser trabeculoplasty had a mean IOP of 16.5 mm Hg, with an average decrease of 24% at 12 months from preoperative IOP. Eyes with no previous trabeculoplasty had a mean IOP of 15.7 mm Hg, with an average decrease in IOP of 30%. Data showed that mean use of adjunctive glaucoma medications decreased to 1.5 medications in patients with no previous laser trabeculoplasty and 2.1 medications among patients with previous laser surgery.
“The pseudophakic and combined patients, whether they had laser trabeculoplasty or not, there was no difference between any of the groups,” Dr. Vold said. “But in the phakic patients that underwent Trabectome only, the patients that underwent laser trabeculoplasty did appear to need a little bit more medications.”
Mechanical and cellular effects
One limitation of the study was a lack of data on specific types of laser trabeculoplasty patients had undergone and on the time interval between laser surgery and Trabectome, the authors said.
Dr. Vold emphasized the low complication rate of Trabectome surgery performed alone or combined with phacoemulsification. – by Matt Hasson
Reference:
- Vold SD, Dustin L, Trabectome Study Group: Impact of laser trabeculoplasty on Trabectome outcomes. Ophthalmic Surg Lasers Imaging. 2010;41:443-451.
- Steven D. Vold, MD, can be reached at Boozman-Hof Regional Eye Clinic, PA, 3737 W. Walnut, Rogers, AR 72756; 479-246-1700; 479-366-4570; e-mail: svold@cox.net; website: www.boozmanhof.com.
