Combined YAG-laser activation of trabecula and selective laser trabeculoplasty in the treatment of primaryopen-angle glaucoma

Purpose. To develop technique and evaluate changes in the levelof intraocular pressure of combined YAG-laser activation of trabecula(YAG-LAT) and selective laser trabeculoplasty (SLT) in the treatment ofprimary open-angle glaucoma (POAG). Material and methods. Analysis of intraocular pressure levels after treatment in 131 patients (131 eyes)with early, moderate and advanced POAG treated at Eye MicrosurgeryYekaterinburg Center were evaluated. All patients were divided into2 groups. Group I included 62 eyes with combined treatment — YAGLAT and SLT according to method developed at the Center. Group II included 69 eyes with SLT alone. Follow-up period was 12 months. Results. In 1 month after treatment a statistically significant decreaseof intraocular pressure (IOP) was found in both groups — by 34% frombaseline in group 1 and by 28% in group 2. In 12 months IOP statisticallysignificantly decreased by 30% in group 1 and by 17% in group 2. By theend of follow-up, group 1 showed a statistically significant decrease ofIOP from baseline by 33% in POAG stage I (early), 27% in POAG stageII (mild), and by 26% in POAG stage III (advanced); The target IOP ingroup 1 at stage I (early) of glaucoma was achieved in 98% of cases, atstage II (mild) in 90% of cases, at stage III (advanced) in 67% of cases;in group 2 IOP decrease by POAG stages was 21, 13 and 2%, respectively. Conclusion. Combined use of YAG-LAT and SLT has a pronouncedhypotensive effect which statistically significantly exceeds that of SLTalone, including far-advanced POAG. Obtained results justify routine useof the combined laser technology in clinical practice, and, in certaincases, widening of indications to POAG laser treatment towards moreadvanced stages of the disease. Key words: primary open-angle glaucoma, laser treatment, selectivelaser trabeculoplasty, YAG-laser activation of trabecula