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Relationship between selective laser trabeculoplasty and excisional goniotomy outcomes in glaucomatous eyes

Published:April 08, 2021DOI:https://doi.org/10.1016/j.jcjo.2021.02.040

      Abstract

      Objective

      To evaluate the relationship between intraocular pressure (IOP)-lowering success with selective laser trabeculoplasty (SLT) and Kahook Dual Blade (KDB) goniotomy in eyes with glaucoma.

      Design

      Retrospective chart review.

      Participants

      30 eyes of 24 patients undergoing phacoemulsification combined with a KDB with 6 months follow-up and who had previously undergone SLT in the same eye.

      Methods

      Data collected from electronic health records included demographic and glaucoma status, IOP and IOP-lowering medication after SLT and KDB. SLT and KDB success were defined as IOP reduction ≥20% or medication reduction ≥1 at 2 and 6 months, respectively.

      Main outcome

      Association between SLT success and KDB success.

      Results

      Overall, SLT was successful in 17 of 30 eyes (56.7%) at 2 months, and KDB was successful in 18 of 30 eyes (60%) at 6 months. Nine of 17 eyes (52.9%) with prior successful SLT had successful subsequent KDB, whereas 9 of 13 (69.2%) with prior unsuccessful SLT had successful KDB. There was no significant relationship between SLT and KDB outcome in these 30 eyes (p = 0.465 by Fisher's exact test).

      Conclusion

      No relationship between success of SLT and subsequent KDB was observed. However, patients with history of failed SLT still benefited from subsequent KDB.

      Résumé

      Objectif

      Évaluer le lien entre la baisse de la pression intraoculaire (PIO) obtenue par trabéculoplastie sélective au laser (TSL) et par goniotomie réalisée au moyen de la lame double Kahook (LDK) en présence de glaucome.

      Nature

      Examen rétrospectif de dossiers médicaux.

      Participants

      Trente yeux de 24 patients devant subir une phacoémulsification combinée à une LDK s'accompagnant d'un suivi de 6 mois et qui avaient préalablement subi une TSL dans le même œil.

      Résultats

      La cueillette des données issues des dossiers médicaux électroniques comprenait les caractéristiques démographiques, l’état du glaucome, la PIO et les médicaments visant à abaisser la PIO après la TSL et la LDK. La réussite de la TSL et de la LDK se définissait comme une baisse ≥ 20 % de la PIO ou une baisse de ≥ 1 médicament à 2 et à 6 mois, respectivement.

      Paramètre principal

      Association entre la réussite de la TSL et la réussite de la LDK.

      Résultats

      Dans l'ensemble, la TSL a réussi dans 17 yeux sur 30 (56,7 %) à 2 mois, tandis que la LDK a réussi dans 18 yeux sur 30 (60 %) à 6 mois. La LDK subséquente a réussi dans 9 des 17 yeux (52,9 %) qui avaient répondu à la TSL, et dans 9 des 13 yeux (69,2 %) où la TSL avait échoué. On n'a enregistré aucun lien significatif entre le résultat de la TSL et celui de la LDK dans ces 30 yeux (p = 0,465 selon le test exact de Fisher).

      Conclusion

      Aucun lien n'a pu être établi entre la réussite de la TSL et l'issue d'une LDK subséquente. Cela dit, certains des patients chez qui la TSL avait échoué ont quand même retiré des bienfaits d'une LDK subséquente.
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