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Tip of the Month
Tip of the month - Patients with pigmentary glaucoma respond well to laser trabeculoplasty, but steps must be taken to reduce the risk of the IOP spike that may occur immediately after the laser treatment
Patients with pigmentary glaucoma respond well to laser trabeculoplasty, but steps must be taken to reduce the risk of the IOP spike that may occur immediately after the laser treatment

Publishing date: April 2014

Tip Editors: John Salmon and Gordana Sunaric M├ęgevand
Tip reviewer: Roger Hitchings


The Science behind the Tip

Argon or selective laser trabeculoplasty (LT) is an established therapeutic option in the treatment of patients with pigment dispersion syndrome and pigmentary glaucoma (1-3).  This treatment is more effective in younger patients than in older patients.  There is a greater chance of failure in patients with pigmentary glaucoma who have had the condition longer and in those with higher pre-treatment IOP. (1)  The effect declines over time (80% control at 1 year, 45% control at 6 years after argon LT.) (2)

A significant concern is the IOP spike that may follow immediately after the laser treatment, presumably secondary to pigment release. (3)  The risk can be reduced by using g.Aproclonidine 1% pre-treatment, by using low laser energy settings and by reducing the number of treatment spots. (3)  These patients should have their IOP checked 2 hours after their procedure.

Contributor: John Salmon, Oxford



References

1. Lieberman MF, Hoskins HD, Hetherington J.  Laser trabeculopasty in pigmentary dispersion syndrome with glaucoma. Am J Ophthalmol 1983; 96:721-725.

2. Ritch R, Leibmann J, Robin A et al.  Argon laser trabeculoplasty in pigmentary glaucoma.  Ophthalmology 1993; 100: 909-913.

3. Harasymowycz PJ, Papamatheakis DG, Latina M et al.  Selective laser trabeculoplasty (SLT) complicated by intraocular pressure elevation in eyes with heavily pigmented trabecular meshworks.  Am J Ophthalmol 2005; 139: 1110-1113.




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