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First Author: I.El-Hawary SAUDI ARABIA
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To compare the efficacy of Selective Laser Trabeculoplasty (SLT) in Lowering the Intraocular Pressure (IOP) in patients with Primary Open Angle Glaucoma (POAG) and patients with Pseudoexfoliative Glaucoma (PXFG)
Glaucoma Service Unit, Magrabi Eye Center, North Jeddah, Saudi Arabia
The effectiveness of SLT was compared in 20 eyes of 20 patients with PXFG (Uncontrolled by maximally tolerated anti-Glaucoma medications) and 24 eyes of 24 patients with POAG. Analysis was done between the year of 2009 and 2012. All POAG and PXFG patients were white. 60 % of the POAG group and 40 % of the PXFG group received treatment of the entire angle in two divided sessions aiming to reduce the IOP to be less than or equal to 18 mmHg. All second treatments were performed at least four to six weeks after the initial session. IOP was measured before and 1 day, 1 week, 1,6,12 and 24 months after treatment.
The mean +/- SD IOP decreased from 24.2 +/- 1.2 mmHg to 16.9 +/- 2.1 mmHg 6 months after treatment and reached 21.3 +/- 1.7mmHg at 2 years of follow up in the PXFG group. The mean +/- SD IOP decreased from 23.9 +/- 1.1 mmHg to 18.6 +/- 1.7 mmHg at 2 years of follow up in the POAG group (p<0.05). Evaluation of the postoperative course of IOP between the two groups done by means of the Kaplan-Meier curve for data analysis indicated that the PXFG patients Failed at a faster rate than the POAG patients after the laser treatment. The rate of failure in the PXFG group, however, was greater following the initial overall treatment.
Our analysis showed that SLT proved to be effective in the first 6 months following the treatment, dramatically reducing the IOP, but, at long term, its efficacy tends to greatly decrease. This may be due to increase in the production of Metalloproteinases (MMPs) induced by trabecular meshwork Photocoagulation after SLT. Some Authors evaluated changes in MMP-2 and tissue inhibitor of Metalloproteinases (TIMP-2) in PXFG patients by assessing the concentration in the aqueous humour of MMP-2 and TIMP-2 after phacoemulsification in PXFG with cataract and after SLT in PXFG patients. These authors showed a TIMP-2 vs. MMP-2 ratio higher in patients with PXFG cataract and PXFG SLT than in the cataract control group. MMP-2 is the major Metalloproteinase secreted after SLT and is inhibited by TIMP-2. Some cases of PXFG may be at risk of IOP elevation after SLT that may be correlated to the failure to decrease the TIMP-2/MMP-2 ratio.