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Klin Monbl Augenheilkd 2019; 236(10): 1192-1200
DOI: 10.1055/a-0577-7925
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Die Lasertrabekuloplastik in der modernen Glaukomtherapie – ein Überblick

Laser Trabeculoplasty in Modern Glaucoma Therapy – a Review
Roman Greslechner
Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg
,
Detlev Spiegel
Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg
› Author Affiliations
Further Information

Publication History

eingereicht 20 November 2017

akzeptiert 06 February 2018

Publication Date:
11 April 2018 (online)

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Zusammenfassung

Hintergrund Die Lasertrabekuloplastik (LTP) stellt neben medikamentöser Therapie und operativen Interventionen eine etablierte Behandlungsmodalität in der Therapie chronischer Offenwinkelglaukome dar. Dabei besteht eine große Variabilität in der praktischen Anwendung.

Methoden Literaturrecherche über PubMed. Darstellung der wichtigsten evidenzbasierten Daten zur Lasertrabekuloplastik.

Ergebnisse Argonlasertrabekuloplastik (ALT) und selektive Lasertrabekuloplastik (SLT) stellen sichere und effektive Verfahren dar, die zu einer Drucksenkung um 20 – 30% führen. Vergleichbare Erfolgsraten werden für beide Prozeduren berichtet. Im Verlauf muss bei 50% mit einem Therapieversagen nach ca. 2 – 5 Jahren gerechnet werden. Die Wiederholung einer ALT ist mit einer deutlich geringeren Drucksenkung und Wirkdauer verbunden. Auch die Wiederholung einer SLT ist mit einem Wirkverlust verbunden. Die Wirksamkeit der SLT nach initialer ALT konnte nachgewiesen werden, wohingegen Daten zur Wirksamkeit einer ALT nach initialer SLT noch fehlen. Bei fortgeschrittenen Glaukomen unter maximaler medikamentöser Therapie wurden in Hinblick auf zusätzliche Interventionen schlechtere Erfolgsraten berichtet.

Schlussfolgerung Die LTP bietet sich als Ersttherapie und ergänzende Therapie in allen Stadien an. Bei fortgeschrittenen Glaukomen unter maximaler medikamentöser Therapie sind die Erfolgsaussichten aufgrund der notwendigen niedrigen Zieldrücke eingeschränkt.

Abstract

Background Laser trabeculoplasty (LTP) is a well established treatment modality in the management of chronic open angle glaucoma. Nonetheless there is much variation in practice.

Methods A literature search in the PubMed database was conducted and the most important evidence-based results were summarised.

Results Argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) are safe and effective treatment modalities, achieving an IOP reduction of 20 – 30%. Similar success rates have been reported for both procedures. A 50% rate of failure occurs after 2 – 5 years. Repeat-ALT is associated with a lower IOP decrease and a shorter duration of treatment effect. Repetition of SLT after initial SLT seems to be associated with loss of efficiency as well. SLT has been shown to be successful after initial ALT, whereas there are no data on ALT after initial SLT. For advanced glaucoma on maximum medical therapy, low success rates have been reported with regard to additional interventions.

Conclusion LTP is a good option for initial and adjunctive treatment. In advanced glaucoma on maximum medical therapy, low target pressures are needed, and filtering surgery has to be considered.

Schlüsselwörter

Glaukom - Argonlasertrabekuloplastik - selektive Lasertrabekuloplastik

Key words

glaucoma - argon laser trabeculoplasty - selective laser trabeculoplasty
 

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