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Abstract #5470 Published in IGR 1-2
Reaffirming the role of the laser in glaucoma management (editorial)
Higginbotham EJArchives of Ophthalmology 1999; 117: 1076
The author discusses the roles of trabeculoplasty and cycloablation, which according to her, have been de-emphasized in recent years. In the case of laser trabeculoplasty, she discusses the results of the AGIS study and of the Normal Tension Glaucoma Study. In the AGIS study, she states it has been reported that laser trabeculoplasty followed by filtering surgery in blacks has a better result than in the reverse order. This was not the case in whites. Although filtration surgery achieved lower pressure in each group, in the black participants, the patients who underwent laser trabeculoplasty first fared better. In the case of the Low Tension Glaucoma Study, she points out that cataract developed in 40% of cases in the control group and in 38% of cases in the treatment group. Most of the cataracts developed after filtering surgery. Thus, she feels that intraocular pressure-reducing interventions not associated with adverse effects such as lenticular opacities should be considered. One such intervention would be laser trabeculoplasty. She also feels that laser trabeculoplasty does not constitute a risk for encapsulated blebs after filtering surgery. As far as laser cyclodestruction is concerned, she mentions a small retrospective study which compared mitomycin-C trabeculectomy, glaucoma drainage device surgery, and cyclophotocoagulation, but did not find a difference between these three methods. However, it seems that the evidence for using cyclodestruction before other surgical interventions is not overwhelming. Finally, she returns to studies that compared medical treatment with laser treatment, which showed that both treatment modalities have the same effect on the intraocular pressure.
Dr. E.J. Higginbotham, Department of Ophthalmology, University of Maryland Medical Center, 22 S Greene Street, Baltimore, MD 21201; USA
Classification:
12.4 Laser trabeculoplasty and other laser treatment of the angle (Part of: 12 Surgical treatment)
12.10 Cyclodestruction (Part of: 12 Surgical treatment)
