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The main objection to argon laser trabeculoplasty is collateral tissular injury, requiring hazardous repeated sessions if tonometric efficacy decreases. Selective trabeculoplasty could allow reliably effective iterative sessions because it is relatively harmless to tissues. Two other physical methods are on the market, although they are still being investigated, which also allow repeated treatments with minimal trabecular impairment. Titanium:sapphire laser trabeculoplasty consists of a very short pulse duration, with a wavelength penetrating deeply into the trabecula meshwork; the first results indicate similar intraocular pressure reduction as that obtained with argon trabeculoplasty and selective trabeculoplasty, but point out a possible risk of a paradoxical pressure rise during the days following the procedure. Pneumotrabeculoplasty is a procedure that uses ocular stretching by suction, which could finally provide a long-lasting decrease in intraocular pressure, less than that obtained with lasers, but its harmlessness is proved and its cost much lower. LA: French
Dr. E. Sellem, Centre Ophtalmologique Kléber, 50, cours Franklin-Roosevelt, 69006 Lyon, France