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

• Main Authors: N. I. Kurysheva, V. N. Trubilin, S. G. Kapkova, L. V. Lepeshkina
• Format: Article
• Language: Russian
• Published: Eco-vector 2018-12-01
• Series: Клиническая практика
• Subjects: selective laser trabeculoplasty; primary open angle glaucoma; primary angle closure glaucoma; predictors of slt effectiveness; corneal endothelium; confocal microscopy
• Online Access: https://journals.eco-vector.com/clinpractice/article/viewFile/10621/8368
• ISSN: 2220-3095; 2618-8627

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 m, 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 m) 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.