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Klin Monbl Augenheilkd 2007; 224(3): 173-179
DOI: 10.1055/s-2007-963014
Klinische Studie

© Georg Thieme Verlag KG Stuttgart · New York

Augendrucksenkung nach selektiver Lasertrabekuloplastik (SLT) mit zwei unterschiedlichen Lasersystemen und nach Argonlasertrabekuloplastik (ALT) - Eine kontrollierte prospektive klinische Studie an 284 Augen

Pressure Reduction After Selective Laser Trabeculoplasty with Two Different Laser Systems and After Argon Laser Trabeculoplasty - A Controlled Prospective Clinical Trial on 284 EyesU.-P Best1 , H. Domack1 , V. Schmidt1
  • 1Augenklinik und Augenlaserklinik Mainfranken
Further Information

Publication History

Eingegangen: 21.9.2006

Angenommen: 6.2.2007

Publication Date:
26 March 2007 (online)

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Zusammenfassung

Hintergrund: Die selektive Lasertrabekuloplastik (SLT) ist eine Weiterentwicklung und ein schonender Ersatz der Argonlasertrabekuloplastik (ALT), sie zählt als eine potenziell früh anwendbare Lasertherapie. In dieser prospektiven randomisierten einfach verblindeten Studie haben wir Langzeitergebnisse nach SLT mit zwei unterschiedlichen Lasersystemen und nach ALT mit einem Argonlaser verglichen. Patienten und Methoden: Vor circa zwei Jahren haben wir 119 Augen mit dem SLT-Lasersystem I und 124 Augen mit dem SLT-Lasersystem II behandelt, 41 Augen erhielten eine ALT. Ergebnisse: In unserer Verlaufsbeobachtung konnte eine durchschnittliche Augeninnendrucksenkung von 1,9 mmHg beziehungsweise 8,8 % zwei Monate nach SLT mit dem SLT-Lasersystem I erzielt werden. Nach SLT mit dem SLT-Lasersystem II erreichten wir nach zwei Monaten eine Drucksenkung von 2,0 mmHg oder 9,5 %, nach ALT 2,2 mmHg beziehungsweise 9,9 %. Die Augen nach Lasertrabekuloplastik mit dem SLT-I-System zeigten einen sehr ähnlichen Drucksenkungsverlauf wie die Augen nach Lasertrabekuloplastik mit dem SLT-II-System und nach Argonlasertrabekuloplastik. Schlussfolgerungen: Nach ALT mit dem Argonlaser war die Drucksenkung am größten und nach SLT mit dem SLT-Laser-I am geringsten, die Druckwerte nach SLT mit dem SLT-II-Laser lagen dazwischen. Die in der Literatur für die SLT und die ALT angegebene durchschnittliche Drucksenkungsrate von 25 % konnte in unseren eigenen Untersuchungen nicht bestätigt werden. Die nichtthermische Technik der SLT erwies sich dennoch als nützliche und sehr sichere Behandlungsmethode zur Senkung des Augeninnendruckes, weil sie praktisch nebenwirkungsfrei ist und die Komplikationen der medikamentösen Behandlung vermeidet. Für die frühen Glaukomformen stellt die SLT eine Alternative zur Tropfentherapie dar, für fortgeschrittene Glaukome bietet die SLT eine Option zur zusätzlichen Druckreduktion. Weitere Untersuchungen zur Effektivität bei unterschiedlich pigmentiertem Trabekelwerk und nach wiederholter SLT sind erforderlich.

Abstract

Background: Selective laser trabeculoplasty (SLT) is a new method to reduce intraocular pressure in eyes with primary open angle glaucoma. The laser parameters of a Q-switched, frequency-doubled Nd:YAG-laser are set to selectively target pigmented trabecular meshwork cells without visible damage to the adjacent non-pigmented tissue. SLT acts non-thermally, the intracellular microdisruptions triggered by the laser are confined to the targeted cells, the laser pulses are so short that heat caused within the targeted cells does not have time to spread to the surrounding tissue. A controlled prospective randomised clinical study was conducted to compare the long-term results, safety and efficacy after SLT with two different laser systems and after ALT in the treatment of ocular hypertension and medically uncontrolled open angle glaucoma. Patients and Methods: About two years ago the authors performed a selective laser trabeculoplasty in 119 eyes using the SLT laser unit Otello (Glautec AG, ARC, EC), here named as SLT-I, and in 124 eyes using the SLT laser unit Selecta II (Lumenis, Palo Alto, CA), here named as SLT-II. In 41 eyes the authors performed argon laser trabeculoplasties using the argon laser Argus (Aesculap Meditec, EC). Results: Two months after treatment mean IOP reduction from baseline was 1.9 mmHg or, respectively, 8.8 % after SLT with the SLT-System I, 2.0 mmHg or, respectively, 9.5 % after SLT with SLT-System II, and 2.2 mmHg or, respectively, 9.9 % after ALT with the argon laser. Twelve months after LTP mean pressure reductions were 1.7 mmHg (7.9 %) after SLT-I, 1.8 mmHg (8.5 %) after SLT-II, and 2.1 mmHg (9.4 %) after ALT. The response curve of the eyes with SLT-I greatly resembled that of the eyes with SLT-II and those eyes with ALT. Conclusions: Pressure reduction was highest after ALT, followed by SLT-II, in SLT-I reduction was the least, but the differences were not significant. Our findings did not correspond with those of other authors reporting an average IOP reduction of 25 % after SLT and ALT. SLT has shown reasonable efficacy in lowering IOP in eyes with ocular hypertension and primary open angle glaucoma, SLT achieves about the same level of IOP reduction compared with ALT. As a result of the preservation of the structure of the trabecular meshwork and low rate of complications, SLT is a safe alternative to ALT. The exact biological effect induced with SLT is still not yet understood. For the early glaucoma stages SLT provides an alternative to drug treatment, for the advanced glaucomas SLT is an additional option for further pressure reduction. More long-term follow-up studies are needed to determine whether the IOP lowering effect is sustained over time, and to assess the efficacy of repeated SLT.

Schlüsselwörter

selektive Lasertrabekuloplastik - SLT - Argonlasertrabekuloplastik - ALT - Glaukom

Key words

selective laser trabeculoplasty - SLT - argon laser trabeculoplasty - ALT - glaucoma

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Dr. Ulrich-Peter Best

Am Oberen Marienbach 1

97421 Schweinfurt

Phone: ++49/97 21/4 74 23 90

Fax: ++49/97 21/18 89 18

Email: UPBest@t-online.de