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Influence of Previous Argon Laser Trabeculoplasty on Intraocular Pressure and Scarring following Trabeculectomy

Wimmer I., Picht G., Grehn F.,
Bayerische Julius-Maximilians-Universität Würzburg, Universitäts-Augenklinik (Würzburg)

Purpose: To evaluate the influence of previous Argon Laser Trabeculoplasty (ALT) on the result of trabeculectomy. Postoperative criteria included intraocular pressure (IOP), bleb scarring and the need for postoperative therapeutical intervention.
Methods: In this prospective study 80 eyes with primary (n = 77) or secondary (n = 3) trabeculectomy were included, 51 eyes with Primary Open Angle Glaucoma (POAG) and 29 eyes with Exfoliation Glaucoma (XFS). In 27 out of 80 eyes, Argon Laser Trabeculoplasty (ALT) was previously performed. Postoperative IOP, therapeutic interventions like the subconjunctival injection of antimetabolite 5-Fluorouracil and needling and morphologically standardized bleb assessment was compared between the ALT treated and non-pretreated group. Blebs with signs of scarring were treated with 5-FU and if unsuccessful, needling was performed, independently of ALT pretreatment. IOP and bleb assement was performed daily until discharge, after 2 weeks and 2-3 months.
Results: Postsurgical IOP did not show significant differences between the ALT treated and non-ALT pretreated group (with ALT: 13.3 mm Hg ± 3.4 mmHg; without ALT: 12.7 mmHg ± 4.3 mm Hg. P = 0.53 student t-test). In POAG, scarring and the use of antimetabolites and needling was similar between the ALT treated and non-ALT pretreated eyes (P = 0.936, Fisher’s exact test). Interestingly, all XFS-Glaucoma patients with ALT pretreatment showed postoperative scarring (n = 5). In non- ALT pretreated XFS eyes only 47 % ( 9/19) had a tendency of scarring (P = 0.05, Fisher's exact test).
Conclusions: In POAG, previous ALT does not influence postoperative IOP or the need for therapeutic interventions. In XFS-glaucoma however, ALT seems to favour postoperative bleb scarring in our study.