[Efficiency and Therapy Safety of Fractionated Cyclophotocoagulation with up to Ten Laser Spots for Advanced Primary Open-Angle and Pseudoexfoliation Glaucoma].

Abstract:

BACKGROUND:Various procedures are available for the treatment of advanced glaucoma. We examined the efficacy and safety of fractionated cyclophotocoagulation (CPC) with up to ten laser spots for advanced primary open-angle glaucoma (POAG) and pseudoexfoliation (PEX) glaucoma treated with maximal topical therapy or eye-drop intolerance. MATERIAL UND METHODS:This retrospective study evaluated data from 297 eyes with advanced POAG and PEX glaucoma which received 10 applications of CPC between February 2012 and June 2017. Intraocular pressure (IOP), number of topical eye drops and postoperative complications were evaluated. Data were collected preoperatively, four weeks postoperatively, and at the last documented contact (six months postoperative visit). The paired Wilcoxon rank sum test was used to analyse the changes. RESULTS:The IOP for open-angle glaucoma decreased from 16.66 ± 4.36 mmHg preoperatively to 13.87 ± 3.59 mmHg at the last visit (6 months postoperative visit; p < 0.05). The IOP for the PEX glaucoma decreased significantly from 20.76 ± 9.55 mmHg preoperatively to 15.50 ± 5.93 mmHg at the last visit (p < 0.003). The number of hypotensive agents in the POAG was 2.51 ± 1.00 preoperatively and at the last visit 2.27 ± 1.03. In PEX glaucoma, the number of hypotensive agents was 2.46 ± 1.07 preoperatively and at the last visit 1.88 ± 0.97. Treatment-related complications occurred in three eyes - two cases of postoperative macular oedema, which were treated well with systemic steroids, and one case of pretreated anterior chamber irritation with hyphema, which was also treated with topical steroids. CONCLUSION:In our group of patients, the mild CPC performed by us with a maximum of 10 applications (vs. the conventional 20 - 30 applications) produced a good reduction of intraocular pressure, as well as a reduction in topical medication, with a low complication rate. HINTERGRUND:Zur Therapie weit fortgeschrittener Glaukome stehen verschiedene Verfahren zur Verfügung. Wir untersuchten die Effektivität und Therapiesicherheit der fraktionierten Zyklophotokoagulation (CPC) mit bis zu 10 Herden für fortgeschrittene primäre Offenwinkelglaukome (POWG) und Pseudoexfoliationsglaukome (PEX-Glaukome), die mit maximaler topischer Therapie behandelt wurden oder eine Augentropfenunverträglichkeit aufwiesen. MATERIAL UND METHODEN:In dieser retrospektiven Studie wurden die Daten von 297 Augen ausgewertet, die zwischen Feb. 2012 und Jun. 2017 eine CPC von je 10 Herden erhielten und an einem fortgeschrittenen POWG bzw. einem PEX-Glaukom litten. Ausgewertet wurden Augeninnendruck (IOD), Anzahl drucksenkender Wirkstoffe sowie postoperative Komplikationen. Die Daten wurden präoperativ, 4 Wochen postoperativ sowie zum letzten dokumentierten Kontakt (i. d. R. 6 Monate postoperativer Visit) erhoben. Für die Analyse der Änderungen wurde der gepaarte Wilcoxon-Rangsummentest verwendet. ERGEBNISSE:Der IOD ist für die POWG von 16,66 ± 4,36 mmHg präoperativ auf 13,87 ± 3,59 mmHg zum letzten Visit (i. d. R. 6 Monate postoperativer Visit) statistisch signifikant (p < 0,05) gesunken. Der IOD ist für die PEX-Glaukome von 20,76 ± 9,55 mmHg präoperativ auf 15,50 ± 5,93 mmHg zum letzten Visit signifikant (p < 0,003) gesunken. Die Anzahl der drucksenkenden Wirkstoffe lag beim POWG präoperativ bei 2,51 ± 1,00; beim letzten Visit bei 2,27 ± 1,03 sowie beim PEX-Glaukom präoperativ bei 2,46 ± 1,07; beim letzten Visit bei 1,88 ± 0,97. Behandlungsbedürftige Komplikationen traten insgesamt bei 3 Augen auf, es zeigten sich 2 postoperative Makulaödeme, die sich mit systemischen Steroiden gut behandeln ließen, sowie ein therapiebedürftiger Vorderkammerreizzustand mit Hyphäma, der ebenfalls mit topischen Steroiden behandelt wurde. SCHLUSSFOLGERUNG:Auch die von uns durchgeführte milde CPC mit maximal 10 Herden (vs. der oft applizierten 20 – 30 Herde) zeigt in unserem Kollektiv eine gute Augeninnendrucksenkung mit im Mittel einer Reduktion der zu applizierenden topischen Antiglaukomatosa bei geringer Komplikationsrate.

journal_name

Klin Monbl Augenheilkd

authors

Grohmann C,Farrokhi S,Klemm M

doi

10.1055/a-1057-9699

subject

Has Abstract

pub_date

2020-02-03 00:00:00

eissn

0023-2165

issn

1439-3999

pub_type

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