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      Pneumatic Trabeculoplasty versus Argon Laser Trabeculoplasty in Primary Open-Angle Glaucoma

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          Abstract

          Aims: To compare the efficacy of pneumatic trabeculoplasty (PNT) and argon laser trabeculoplasty (ALT) in primary open-angle glaucoma (POAG) uncontrolled with two topical therapies. Methods: In a randomized, prospective clinical study, 32 patients received in 1 eye PNT or ALT. Results: At 1 month, in PNT- and in ALT-treated eyes respectively, mean intraocular pressure (IOP) decreased by 3 ± 2.3 and 5.7 ± 1.7 mm Hg (12.7 ± 9.6 and 24.4 ± 7.4%, both paired t test p < 0.001); 5 and 13 eyes (31 vs. 81%, χ<sup>2</sup> test p = 0.013) had an IOP reduction ≥20%, 7 and 1 eyes had an insufficient effect (IOP >20 mm Hg). Only 1 PNT-treated eye had IOP reduction ≥20% until 4 months. At 6 months, 10 ALT-treated eyes (62.5%) had IOP reduction ≥20%; 15 PNT- and 3 ALT-treated eyes had an insufficient effect (94 vs. 19%, p < 0.001). Transient anterior segment side effects, but not visual field or fundus changes, occurred after both treatments. Conclusions: PNT is less effective than ALT in POAG uncontrolled with two topical therapies.

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          Most cited references 18

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          Extracellular matrix in the trabecular meshwork.

          The extracellular matrix (ECM) of the trabecular meshwork (TM) is thought to be important in regulating intraocular pressure (IOP) in both normal and glaucomatous eyes. IOP is regulated primarily by a fluid resistance to aqueous humor outflow. However, neither the exact site nor the identity of the normal resistance to aqueous humor outflow has been established. Whether the site and nature of the increased outflow resistance, which is associated with open-angle glaucoma, is the same or different from the normal resistance is also unclear. The ECMs of the TM beams, juxtacanalicular region (JCT) and Schlemm's canal (SC) inner wall are comprised of fibrillar and non-fibrillar collagens, elastin-containing microfibrils, matricellular and structural organizing proteins, glycosaminoglycans (GAGs) and proteoglycans. Both basement membranes and stromal ECM are present in the TM beams and JCT region. Cell adhesion proteins, cell surface ECM receptors and associated binding proteins are also present in the beams, JCT and SC inner wall region. The outflow pathway ECM is relatively dynamic, undergoing constant turnover and remodeling. Regulated changes in enzymes responsible for ECM degradation and biosynthetic replacement are observed. IOP homeostasis, triggered by pressure changes or mechanical stretching of the TM, appears to involve ECM turnover. Several cytokines, growth factors and drugs, which affect the outflow resistance, change ECM component expression, mRNA alternative splicing, cellular cytoskeletal organization or all of these. Changes in ECM associated with open-angle glaucoma have been identified.
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            Comparison of long-term outcomes of selective laser trabeculoplasty versus argon laser trabeculoplasty in open-angle glaucoma.

            To compare the long-term success rate of selective laser trabeculoplasty (SLT) versus argon laser trabeculoplasty (ALT). Retrospective chart review. One hundred ninety-five eyes of 195 patients with uncontrolled open-angle glaucoma (OAG), of which 154 eyes underwent ALT and 41 eyes underwent SLT and were followed up for a maximum of 5 years. The SLT patients were treated with the frequency-doubled q-switched neodymium:yytrium-aluminum-garnet laser (532 nm). Approximately 50 to 55 nonoverlapping spots were placed over 180 degrees of the trabecular meshwork at energy levels ranging from 0.6 to 1.0 mJ per pulse. The ALT patients were treated with the argon blue-green laser with between 45 to 55 adjacent, nonoverlapping spots over 180 degrees of the trabecular meshwork at 470 to 1150 mW of energy per pulse. The success rates were defined by criterion I and criterion II. Success by criterion I was defined as a decrease in intraocular pressure (IOP) of 3 mmHg or more with no additional medications, laser, or glaucoma surgery. Criterion II had the same requirements as criterion I, except that a 20% or more IOP reduction was required for success. The mean follow-up time was 37.4+/-14.7 months for patients in the SLT group and 33.6+/-17.0 months for patients in the ALT group. The long-term success rate was not significantly different between the ALT and SLT groups by either criterion (Kaplan-Meier survival analysis log-rank P = 0.20 by criterion I and P = 0.12 by criterion II). When comparing patients with and without previous ALT, there was not a statistically significant difference in the patients treated with SLT by either criterion (log-rank P = 0.37 by criterion I and P = 0.39 by criterion II). In eyes with primary OAG that are receiving maximally tolerated medical therapy, SLT was found to be as effective as ALT in lowering IOP over a 5-year period. However, long-term data reveal that many of the glaucoma patients treated with SLT and ALT required further medical or surgical intervention. Whether SLT has better long-term success than ALT in repeat laser trabeculoplasty treatments remains unclear.
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              Selective laser trabeculoplasty versus argon laser trabeculoplasty: results from a 1-year randomised clinical trial.

              To compare selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT), in terms of intraocular pressure (IOP) lowering, in patients with open-angle glaucoma. 176 eyes of 152 patients were enrolled in this study, 89 in the SLT and 87 in the ALT groups. Patients were randomised to receive either SLT or ALT treatment to 180 degrees of the trabecular meshwork. Patients were followed up to 12 months after treatment. The main outcome measured was IOP lowering at 12 months after treatment, compared between the SLT and ALT groups. No significant difference (p = 0.846) was found in mean decrease in IOP between the SLT (5.86 mm Hg) and ALT (6.04 mm Hg) groups at 1 year or at any other time points, nor were there any significant differences in the rate of early or late complications between the two groups. SLT is equivalent to ALT in terms of IOP lowering at 1 year, and is a safe and effective procedure for patients with open-angle glaucoma.
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                Author and article information

                Journal
                OPH
                Ophthalmologica
                10.1159/issn.0030-3755
                Ophthalmologica
                S. Karger AG
                0030-3755
                1423-0267
                2010
                December 2009
                07 October 2009
                : 224
                : 1
                : 10-15
                Affiliations
                Institute of Ophthalmology, University of Catania, Catania, Italy
                Article
                243765 Ophthalmologica 2010;224:10–15
                10.1159/000243765
                19684423
                © 2009 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 2, Tables: 3, References: 32, Pages: 6
                Categories
                Original Paper

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