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Excimer Laser Trabeculotomy from Interno - Principles and First Applications

Foja C., Wiedemann P.,
Universität Leipzig, Klinik und Poliklinik für Augenheilkunde (Leipzig)

Purpose: Surgical methods to ameliorate the outflow facility of aqueous humor are being developed constantly. Area of special interest are alternatives to the standardized surgical procedures minimalizing the risks of an intraocular operation for glaucoma. Excimer laser trabeculotomy (ELT) ab interno is supposed to provide openings from the anterior chamber to Schlemm`s canal.
Method: In our first project of ELT we enclosed four eyes of four patients with an pharmacologically not regulated primary open angle glaucoma, progressive glaucomatous damages of the optical nerve head and in the visual field (classification of AULHORN stage 3 -5). They were examined for six months. Case I: male, 39 years, intraocular pressure (IOP) before ELT 21 mm Hg; Case II. male, 76 years, IOP before laser surgery 23 mm Hg; Case III: female, 72 years, IOP before ELT 35 mm Hg; Case IV: male, 58 years, preoperative IOP 24 mm Hg.
Results: Case I reached an IOP of 28 mm Hg 1 week p.o. and 14 mm Hg after six months, oculodynamography didn`t show any difference in ocular outflow facility for this patient; Case II had 1 week p.o. an IOP of 17 mm Hg and after 6 months 15 mm Hg; Case III decreased to 23 mm Hg after 1 week and to 18 mm Hg after six months; IOP of Case IV was reduced to 15 mm Hg after 1 week and came up to 20 mm Hg after the 6 month period. All of these patients needed a constant pattern of two or three antiglaucomatous eyedrops before and after the laser treatment.
Conclusions: In other studies from the literature and after our first applications there are some indications that ELT is able to lower the IOP absolutely and also to reach the target pressure in dependance on the preoperative level. Increasing of the IOP in the perioperative period is also possible because of the use of viscoelastics during the surgery. Further studies including more patients are necessary to determine the real efficacy and the long time course of IOP after ELT. Principles of the method and clinical images of the chamber angle after surgery will be demonstrated.