The main objectives of glaucoma treatment are normalization of IOP and slowing of the progression of glaucomatous optic neuropathy. They are achieved using conservative (medicated), surgical and laser methods.
To study the effectiveness of non-penetrating hypotensive laser sclerotomy (NHLS) in patients with non-stabilized primary open-angle (I-III) b glaucoma with previous laser trabeculoplasty and who are receiving drug therapy.
The study included 54 patients (102 eyes) with initial (38 eyes), developed (46 eyes) and advanced (18 eyes) glaucoma who were examined and operated on. 26 patients (46 eyes) were instilled a combined drug containing brinzolamide and timolol, 28 patients (56 eyes) received prostaglandin F2α analogues (PGA). Intraocular pressure (IOP) levels were 27±2.4 mm Hg.
Reduction of IOP was observed in 89% of patients 2 weeks after NHLS with gradual improvement during the first 3 months of the follow-up; in 71% of patients the results preserved by the 6 month. Patients receiving combination of brinzolamide and timolol had more pronounced IOP reduction after NHLS amounting to 2.4±1.8 mm Hg in the first 3 months. By the end of the observation period IOP levels remained within normal range, drug therapy was ceased in 16 patients (21 eyes, 20.6%), 32 patients (67 eyes, 65.7%) achieved normalized intraocular pressure with antihypertensive therapy, and 9 patients (9 eyes, 8.8%) were referred to surgical treatment.
Non-penetrating hypotensive laser sclerotomy (NHLS) allows measured reduction of IOP in various glaucoma stages achieving controlled and persistent hypotensive effect. In the group of patients receiving combination of brinzolamide and timolol, the effect is statistically significant and clinically superior when compared with patients receiving PGA.