Development of a new algorithm for treatment of primary angle closure glaucoma

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Abstract

Purpose – to develop a new algorithm for treatment of primary angle closure glaucoma (PACG) based on laser peripheral iridotomy (PI) and selective laser trabeculoplasty (SLT) and to determine its indications and contraindications. 68 eyes with PACG were observed for 6 years. These patients had undergone PI and then SLT. The control group included 74 POAG eyes of the same age and stage of glaucoma. The effectiveness of SLT was assessed using the Kaplan-Meier survival analysis. The risk factors for SLT failure in the long-term period were studied to determine the indications and contraindications for this treatment algorithm, and the condition of corneal endothelium in dynamics was investigated using confocal microscopy. The hypotensive effect of SLT in PACG was worse than in POAG: 90 and 93% respectively one year after SLT, and 16 and 21% six years after SLT (log rank test, p=0.195). The following factors of SLT failure were common for both forms of glaucoma: IOP >24 mm Hg, corneal thickness ≤540 µm, corneal hysteresis <7 mm Hg and age of patients >68 years. The extension of laser action <1800 and lens thickness >4.8 mm were additional predictors of SLT failure in PACG. In both forms of glaucoma, diabetes mellitus, age of patients and duration of the disease before SLT had a negative effect on the condition of corneal endothelium. The anterior-posterior axis and the presence of pigment deposition on the endothelium were significant in PACG. The proposed algorithm for PACG treatment, including the initial performance of PI and then SLT, is an effective method of treating this form of glaucoma, provided that the opening of the anterior chamber angle is sufficient (at least half) and the lens thickness is no more than 4.8 mm. The initially high IOP, the age of patients over 68 and a thin cornea (<540 μm) worsen the SLT prognosis. Moreover, diabetes mellitus and the presence of pigment deposition on the endothelium along with long-term glaucoma history increase the risk of corneal endothelium damage after SLT.

About the authors

N. I. Kurysheva

The Ophthalmological Center of the FMBA of Russia; State Research Center Burnasian Federal Medical Biophysical Center of the FMBA of Russia; Chair of Ophthalmology of the Institute of Advanced Training of the FMBA of Russia

Author for correspondence.
Email: e-natalia@list.ru

д.м.н., профессор, руководитель консультативно-диагностического отдела Центра офтальмологии ФМБА России, профессор кафедры офтальмологии Института повышения квалификации ФМБА России

Russian Federation, Moscow

V. N. Trubilin

The Ophthalmological Center of the FMBA of Russia; State Research Center Burnasian Federal Medical Biophysical Center of the FMBA of Russia; Chair of Ophthalmology of the Institute of Advanced Training of the FMBA of Russia

Email: trubilinmd@mail.ru

д.м.н., профессор, руководитель Центра офтальмологии ФМБА России, заведующий кафедрой офтальмологии Института повышения квалификации ФМБА России

Russian Federation, Moscow

S. G. Kapkova

The Ophthalmological Center of the FMBA of Russia; State Research Center Burnasian Federal Medical Biophysical Center of the FMBA of Russia; Chair of Ophthalmology of the Institute of Advanced Training of the FMBA of Russia

Email: doctor_Kapkov@mail.ru

к.м.н., врач-офтальмолог ЦОМХГ Центра офтальмологии ФМБА России, доцент кафедры офтальмологии Института повышения квалификации ФМБА России

Russian Federation, Moscow

L. V. Lepeshkina

The Ophthalmological Center of the FMBA of Russia; State Research Center Burnasian Federal Medical Biophysical Center of the FMBA of Russia; Chair of Ophthalmology of the Institute of Advanced Training of the FMBA of Russia

Email: lep.ludmila2012@yandex.ru

соискатель кафедры офтальмологии Института повышения квалификации ФМБА России

Russian Federation, Moscow

References

  1. Quigley H.A., Broman A.T. The number of persons with glaucoma worldwide in 2010 and 2020 // Br J Ophthalmol. 2006. Vol. 90. No. 3. P. 262–267.
  2. Quigley H.A. Angle-closure glaucoma – simpler answers to complex mechanism: LXVI Edward Jackson memorial lecture // Am J Ophthalmol. 2009. Vol. 148. No. 5. P. 657–669.
  3. Ritch R. The treatment of chronic angle-closure glaucoma // Ann Ophthalmol. 1981. Vol. 13. No. 1. P. 21–23.
  4. Quigley H.A. Long-term follow-up of laser iridotomy // Ophthalmology. 1981. Vol. 88. No. 3. P. 218–224.
  5. Rosman M., Aung T., Ang L.P. et al. Chronic angle-closure with glaucomatous damage: Long-term clinical course in a North American population and comparison with an Asian population // Ophthalmology. 2002. Vol. 109. P. 2227–2231.
  6. Марченко А.Н., Сорокин Е.Л., Данилов О.В. Морфометрические типы хрусталика и их значение в формировании первичной закрытоугольной глаукомы // Современные технологии катарактальной и рефракционной хирурги. М., 2008. С. 189–193.
  7. Gunning F.P., Greve E.L. Lens extraction for uncontrolled angle-closure glaucoma: Long-term follow up // J Cataract Refract Surg. 1998. Vol. 24. No. 10. P. 1347–1356.
  8. Ho C.L., Lai J.S., Aquino M.V. et al. Selectivelaser trabeculoplasty for primary angle closure with persistently elevated intraocular pressure after iridotomy // J Glaucoma. 2009. Vol. 18. No. 7. P. 563–566.
  9. Narayanaswamy A., Christopher K., Istiantoro D.V. et al. Efficacy of selective laser trabeculoplasty in primary angle-closure glaucoma // JAMA Ophthalmol. 2015. Vol. 133. P. 206–212.
  10. Ali Aljasim L., Owaidhah O., Edward D.P. Selective laser trabeculoplasty in primary angle-closure glaucoma after laser peripheral iridotomy: A case-control study // J Glaucoma. 2016. Vol. 25. No. 3. P. e253–e258.
  11. Nagar M., Ogunyomade A., O’Brart D.P. et al. A randomised, prospective study comparing selective laser trabeculoplasty with latanoprost for the control of intraocular pressure in ocular hypertension and open angle glaucoma // Br J Ophthalmol. 2005. Vol. 89. P. 1413–1417.
  12. Katz L.J., Steinmann W.C., Kabir A. et al. SLT/Med Study Group. Selective laser trabeculoplasty versus medical therapy as initial treatment of glaucoma: A prospective, randomized trial // J Glaucoma. 2012. Vol. 21. No. 7. P. 460–468.
  13. Sihota R., Goyal A., Kaur J. et al. Scanning electronmicroscopy of the trabecular meshwork: Understanding the pathogenesis of primary angle closure glaucoma // Indian J Ophthalmol. 2012. Vol. 60. No. 3. P. 183–188.
  14. Shah M., Eliassi-Rad B. Predictive factors of selective laser trabeculoplasty (SLT) outcome in open-angle glaucoma patients // Investigative Ophthalmology & Visual Science. 2012. Vol. 53. P. 5964.
  15. Ayala M., Chen E. Predictive factors of success in selective laser trabeculoplasty (SLT) treatment // Clin Ophthalmol. 2011. No. 5. P. 573–576.
  16. Mao A.J., Pan X.J., McIlraith I. et al. Development of a prediction rule to estimate the probability of acceptable intraocular pressure reduction after selective laser trabeculoplasty in open-angle glaucoma and ocular hypertension // J Glaucoma. 2008. Vol. 17. No. 6. P. 449–454.
  17. Hodge W.G., Damji K.F., Rock W. et al. Baseline IOP predicts selective laser trabeculoplasty success at 1 year post-treatment: Results from a randomised clinical trial // Br J Ophthalmol. 2005. Vol. 89. No. 9. P. 1157–1160.
  18. Pillunat K.R., Spoerl E., Elfes G., Pillunat L.E. Preoperative intraocular pressure as a predictor of selective laser trabeculoplasty efficacy // Acta Ophthalmol. 2016. Vol. 94. No. 7. P. 692–696.
  19. Lee J.W., Liu C.C., Chan J.C., Lai J.S. Predictors of success in selective laser trabeculoplasty for normal tension glaucoma // Medicine (Baltimore). 2014. Vol. 93. P. e236.
  20. Miki A., Kawashima R., Usui S. et al. Treatment outcomes and prognostic factors of selective laser trabeculoplasty for open-angle glaucoma receiving maximal-tolerable medical therapy // J Glaucoma. 2016. Vol. 25. No. 10. P. 785–789.
  21. Kano K., Kuwayama Y., Mizoue S., Ito N. Clinical results of selective laser trabeculoplasty // Nippon Ganka Gakkai Zasshi. 1999. Vol. 103. P. 612–616.
  22. Sun L., Shen M., Wang J. et al. Recovery of corneal hysteresis after reduction of intraocular pressure in chronic primary angle-closure glaucoma // Am J Ophthalmol. 2009. Vol. 147. No. 6. P. 1061–1066.

Supplementary files

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2. Fig. 1. Dynamics of Ophthalmotonus after SLT at POAG and PSP

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3. Fig. 2. Dynamics of the hypotensive regimen (average number of drops) before and after SLT

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4. Fig. 3. The state of the corneal endothelium in PZUG (A, B) and POAG (B, D) before SLT and six months after surgery

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5. Fig. 4. Corneal endothelium in a patient with PSP after LIT. Visible pigment deposits on the endothelium in the form of hyperreflecting deposits

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Copyright (c) 2018 Kurysheva N.I., Trubilin V.N., Kapkova S.G., Lepeshkina L.V.

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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