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Study: Excimer laser trabeculotomy, phaco can reduce IOP for up to 2 years

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Excimer laser trabeculotomy in conjunction with phacoemulsification can help reduce IOP levels over the long-term, according to a study. However, IOP reduction is less effective with excimer laser trabeculotomy alone, the authors say.

Sonja Wilmsmeyer and colleagues at the University of Freiburg in Germany described a new technique to reduce IOP in patients who had glaucoma or ocular hypertension. The technique, called excimer laser trabeculotomy (ELT), involves increasing the outflow of aqueous humor by creating 10 microperforations of the trabecular meshwork with the laser. The average surgical time was about 2 minutes. IOP, visual acuity and glaucoma medication use were determined preoperatively, at 2 to 4 months, at 5 to 7 months, at 11 to 13 months and at 22 to 26 months after surgery. Treatment was found to be successful if postop IOP was less than 21 mm Hg and if the IOP reduction was at least 20%.

ELT reduced the IOP from a mean of 24.1 mm Hg preop to 18.8 mm Hg in 66 patients who were evaluated 2 to 4 months after surgery. IOP dropped to a mean of 20 mm Hg in 51 patients evaluated between 5 and 7 months postop. IOP was reduced to a mean of 18.8 mm Hg in 37 patients who were evaluated between 11 and 13 months, and IOP dropped to a mean of 16.8 mm Hg in 15 patients who were evaluated between 22 and 26 months postop, according to the study.

Combined ELT and phaco reduced the mean IOP from 22.4 mm Hg at baseline to a mean of 16.5 mm Hg in 52 patients in the 2-to-4-month group, to a mean of 16.1 mm Hg in 40 patients in the 5-to-7-month group, to a mean of 16.4 mm Hg in 35 patients in the 11-to-13-month group and to a mean of 12.8 mm Hg in four patients in the 22-to-26-month group.

The study indicated that of the eyes that underwent ELT on its own, 28% needed to undergo additional surgery because of inadequate IOP reduction. In the combination group, 7% needed repeat surgery, authors said.

The study is published in the June issue of Graefe’s Archive for Clinical and Experimental Ophthalmology.