Efficacy of Microwave Pulse Diode Laser and Argon Laser Trabeculoplasty in Patients with Primary Open Angle Glaucoma

Purpose: To compare the efficacy of the microwave pulse diode laser and argon laser trabeculoplasty in primary open angle glaucoma. Study Design: Quasi experimental study. Place and Duration of Study: Shaheed Mohtarma Benazir Bhutto Medical College Lyari and Sindh Government Lyari General Hospital, Karachi, from October, 2017 to March, 2018. Material and Methods: One hundred and sixty patients, between 42 to 61 years with visual acuity of perception of light to 6/36 were enrolled. Patients diagnosed with POAG were included and patients with intraocular pressure of more than 40 mm Hg, previous glaucoma surgery or laser treatment and narrow angle on gonioscopy were excluded. Ophthalmic examination included visual acuity, slit lamp examination, fundus examination and visual field status using Humphrey perimeter. Patients were divided into two groups. Group A received microwave pulse diode laser (810) and Group B received argon laser trabeculoplasty. Average follow up period was 6 months. Success was assessed objectively by measuring intra ocular pressure and subjectively by visual acuity. Results: The average time-period for each procedure was 15 ± 5 minutes. In Group A, mean IOP at first week, first month, third month and sixth month was 20.79, 16.34, 16.21and 16.09 mm Hg respectively. While in Group B, IOP at first week, first, third and sixth month was 16.52, 15.76, 13.62, and 12.54 mm Hg at (P < 0.001 in both groups). Conclusion: Both microwave pulse diode laser and argon laser trabeculoplasty are effective in lowering intra ocular pressures in patients with primary open angle glaucoma.

Is Argon Laser Trabeculoplasty Equivalent to Topical Medication as an Initial Treatment for Primary Open-Angle Glaucoma?

The Glaucoma Laser Trial (GLT) was a randomized, single-blind, controlled clinical trial comparing the efficacy and safety of argon laser trabeculoplasty (ALT) to treatment with topical medication for controlling intraocular pressure (IOP) in patients with newly diagnosed, previously untreated, primary open-angle glaucoma (POAG). The study showed that initial treatment of POAG with ALT is an efficacious and safe alternative to medication therapy, particularly in patients where medical therapy is contraindicated or poor compliance is suspected. The initial use of ALT in the short term has the benefit of reducing the nuisance, inconvenience, and systemic side effects of the topical glaucoma medication alternatives.

Efficacy and Safety of Argon Laser Trabeculoplasty in Lowering Intraocular Pressure as Adjunctive Treatment to Primary Open Angle Glaucoma

Purpose: To assess efficacy and safety of argon laser trabeculoplasty (ALT) to lower intra ocular pressure (IOP) as adjunctive treatment in primary open angle glaucoma (POAG) patients. Study Design: Descriptive Cross Sectional. Place and Duration of Study: Ophthalmology Department, Abbassi Shaheed Hospital from May 2016 to August, 2017. Materials and Methods: Primary open glaucoma patients were selected from eye OPD. Patients with Inflammatory, angle closure, traumatic glaucoma were excluded. Pre laser and Post laser IOP was measured at 1st week then at 1, 3 and 6 months. Data was collected and analyzed on SPSS version 20. There were 114 patients Results: There were 69 (61%) male patients. Mean age of patients was 60.53 ± 10.71 years. Mean pre laser Intraocular pressure was 23.98 ± 10.01 mm Hg. Mean post laser IOP at one month was 15.6 ± 3.25 and at 6 months was 14.8 ± 3.28 mm Hg. Overall mean reduction of IOP was 9.18 mm Hg from baseline, with p value less than < 0.005. Pre laser 3 medications were used by 20 (18%) and 2 medications by 49 (43%). At 6 months follow-up 4 (3.5%) patients were on 3 medications and 31 (37%) were on 2 medications. It has a p value < 0.005. Drug free patients at 6 months follow-up were 37 (33%). Mild iritis was seen in 7 (6.14%) patients. Conclusion: Argon Laser Trabeculoplasty is effective and safe method to control IOP in POAG when used as an adjunct to medical therapy. It also decreases number of drugs used by patients. Key Words: Argon laser trabeculoplasty, intraocular pressure, primary open angle glaucoma.

Experience with argon laser trabeculoplasty in Nigerians

Aim: To report the safety and efficacy of Argon Laser Trabeculoplasty (ALT) in reducing intraocular pressure (IOP).Settings and Design: This was a retrospective study performed on 25 eyes of 25 patients.Methods and Materials: Consecutive patients who met the inclusion criteria for ALT were recruited from the ophthalmic clinic of the University College Hospital Ibadan, Nigeria and followed up for a minimum period of six months. Two criteria were used to define successful response. Criterion 1 was defined as IOP reduction of 3mmHgor more without additional intervention while criterion 2 was IOP reduction of 20% or more from the pretreatment IOPStatistical Analysis: Data was analyzed using SPSS version 16. Frequencies and means were generated to observe patterns of variable distribution among the patients. P value < 0.05 was considered significant.Results: The mean pretreatment IOP was 19.9 ±3.1mmHg, (range of 16 to 26 mmHg). Mean post treatment IOP at 6 months was 14.9 ±2.2 mmHg, (range of 11 to 19 mmHg). Mean IOP reduction at one year was 4.6 mmHg, representing a 22.3% drop. There was a statistically significant greater IOP reduction in eyes (P<0.001) with higherpretreatment IOP. Based on criterion 1 and 2, 84.0% of the patients had successful outcome at six months while at one year, 76.9% were successful based on criterion one.Conclusion: To the best of our knowledge, this is the first study to report the efficacy of ALT in Nigerians. ALT is safe and effective in reducing IOP in Nigerians.Key messages: ALT is safe and effective in reducing intraocular pressure in this population of NigeriansFunding: The present study did not receive any fundsKeywords: Argon laser trabeculoplasty, Nigerians, Primary open angle glaucoma, intraocular pressure, outcome