Micropulse laser trabeculoplasty under maximal tolerable glaucoma eyedrops:treatment effectiveness and impact of surgical expertise

摘要

AIM:To evaluate the effectiveness of micropulse laser trabeculoplasty(MLT)for eyes with open angle glaucoma(OAG)under maximal tolerable glaucoma eyedrops and to assess the effect of expertise performing MLT on its clinical effectiveness.METHODS:Medical records of 42 consecutive eyes of 34 patients diagnosed with OAG who underwent MLT were retrospectively reviewed.The effectiveness was determined using the Kaplan-Meier survival analysis.Failure was defined as an intraocular pressure(IOP)reduction of21 mm Hg during two consecutive follow-up visits,or surgical intervention for OAG.To determine the impact of MLT surgical expertise on clinical effectiveness,the eyes were divided into two groups according to whether the procedure was conducted by an experienced specialist(defined as a glaucoma specialist who had conducted at least ten MLT procedures)or a less experienced glaucoma specialist.The difference in expertise was determined using a log-rank test.RESULTS:MLT was conducted by three glaucoma specialists.The overall survival rates were 0.76,0.48,and 0.44 at 1,3,and 6 mo,respectively.The survival rates for MLT performed by a less experienced glaucoma specialist were 0.62,0.31,and 0.25(n=21 eyes)at 1,3,and 6 mo,respectively,whereas the survival rates for MLT performed by an experienced glaucoma specialist were 0.90,0.64,and 0.64(n=21 eyes)at 1,3,and 6 mo,respectively.The log-rank test showed a significant difference in the survival curves of the two groups(P=0.0061).CONCLUSION:The 6-month effectiveness of MLT for controlling IOP is relatively limited in eyes with OAG using maximal tolerable glaucoma eyedrops.However,its effectiveness may be improved if performed by a glaucoma specialist with sufficient MLT experience.