Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 694
  • Home
  • Print this page
  • Email this page

   Table of Contents      
ARTICLES
Year : 1983  |  Volume : 31  |  Issue : 6  |  Page : 755-758

Argon laser therapy in open angle glaucoma


Sankara Nethralaya, Medical Research Foundation 18, College Road, Madras, India

Correspondence Address:
B Sridhar Rao
Sankara Nethralaya, Medical Research Foundation 18. College Road, Madras
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 6676261

Rights and PermissionsRights and Permissions

How to cite this article:
Rao B S. Argon laser therapy in open angle glaucoma. Indian J Ophthalmol 1983;31:755-8

How to cite this URL:
Rao B S. Argon laser therapy in open angle glaucoma. Indian J Ophthalmol [serial online] 1983 [cited 2020 Jun 4];31:755-8. Available from: http://www.ijo.in/text.asp?1983/31/6/755/29319

Table 4

Click here to view
Table 4

Click here to view
Table 3

Click here to view
Table 3

Click here to view
Table 2

Click here to view
Table 2

Click here to view
Table 1

Click here to view
Table 1

Click here to view
Laser treatment of the trabecular meshwork inan attempt to improve the aqueous outflow was first reported by Krasnov in 1973. Using high power and short bursts of ruby laser energy he was able to make punctures in the trabecular meshwork and reach schelemm's canal in selected parts of the angle. However, the effect did not last for more than few months and repetition of the procedure was necessary. Wise and Witter conceived a totally new concept of applying small non-penetrat­ing laser burns to the trabecular meshwork. This is based on the theory that col­lapse of the trabecular meshwork might be, the major factor in the mechanism of production of open angle glaucoma. Application of non­penetrating burns reverses this collapse thereby produces a fall in intraocular pressure. The present study reports a series of cases of uncontrolled upon angle glaucoma treated with argon laser at Sankara Nethralaya.


  Material and methods Top


The present study is a report of the first seven cases of open angle glaucoma treated between February 1982 to May 1982. All the cases were considered presurgical as they were uncontrolled i.e. progressive field loss and disc changes with maximal tolerated medical therapy. This included miotics, epinephrine and carbonic anhydrase inhibitors in tolerated doses. Timolol maleate 0.5% was used in addi­tion to the above drugs in two cases. This group included one patient intolerant to mio­tics and three to carbonic anhydrase in­hibitors.

Following baseline evaluations were per­formed in all the cases.

1. Complete ophthalmic evaluation includ­ing history, refraction and Gonioscopy with careful documentation of angle struc­tures, pigment and iris contour.

2. Visual field examination with a calibrated Goldmann perimeter.

3. Goldmann applanation tonometry.

4. Dilated fundus examination.

The patients medication schedules were stabilized and when clinically feasible were un­changed during the follow-up period. This was done to assess the effect of the laser treatment alone on intraocular poressure without intro­ducing the variable of medication and modifi­cation. All the patients were informed about the nature of treatment, and the need for sub­sequent filtration surgery should laser therapy fail to control the glaucoma.

Procedure

All the patients were treated as out-patients with topical anaesthesia using 4%, Xylocaine. Continuous wave argon laser Coherent Radia­tion model 900(R was used. A three-mirror gonioscopic contact lens was used. In all pa­tients the gonioscopic mirror gave the best vis­ualization of the a,igle. Approxiniatelv11)1) burns were applied to the pigmented travecu­lar meshwork band above the scleral spur. The burns were evently spaced over the 300 de­grees of the angle [Figure - 1]. In all cases, a 50 micron spot size 0.1 second exposure time and a power setrting of 800 to 1100 milli watts were used. The power level chosen was adequate to produce depigmented spot at the point of im­pact with occasional bubble or scattering of pigment. Eyes with minimal pigmentation re­ceived more power than eyes with dense pig­mentation. Following treatment the patients were asked to continue their regular glaucoma medication; a topical steroid drop three times a day for 3 days was added to the above treat­ment schedule. The patients were seen post­operatively on the 3rd day and later at 2 weeks -and 2 months intervals. Visual acuity, appla­nation tonometry and gonioscopy were per­formed in the follow-up period.


  Observations Top


The age group of the cases treated varied from 11 years to 75 years. There were 4 cases of primary open angle glaucoma. Out of these 2 cases were juvenile in onset [Table - 1]. 3 were cases of open angle glaucoma in aphakia. All cases had advanced glaucomatous cupping with visual field loss. 4 cases had already lost the fellow eye due to glaucoma. In 2 cases. glaucoma was controlled with medical therapy and one case had undergone successful filtra­tion surgery in the fellow eye [Table - 2].

There was a significant fall in the intraocular pressure of 6mm of Hg or more in4 cases. Out of these 2 cases primary open glaucoma, one was a case of juvenile open angle glaucoma and was a case of open angle glaucoma in aphakia. All these four patients had fair­lydense pigmentation in the travecular meshwork.

Out of the three cases which did not show a significant drop in intraocular pressure. Two were cases of open angle glaucoma in aphakia and one was a case of juvenile type of open angle glaucoma. Out of these three cases with poor response to laser therapy one was sub­jected to successful trabeculectomy, one re­fused surgery and in the third case of open angle glaucoma, the drop in pressure was con­sidered sufficient, to avoid a filtration surgery.

Complications

Accidental coagulation of the iris base occurred in 4 cases, which did not appear to affect the final results, Haemorrhage was not noted during the treatment in any of the cases. Post­ treatment complications were very minimal. Only one case had transient iritis which re­sponded to topical steriods. Scatterred svnechiae were observed in 2 cases [Table - 3], they were small, extended upto the trabecular meshwork at the level of the burn and were localized in extent.

Discussion

Out of 4 cases of open angle glaucoma, who had a good response to laser therapy, two were cases of primary open angle glaucoma, one juvenile type of open angle glaucoma, and one had open angle glaucoma in aphakia. Even though the number of patients in this study is very small, certain trends are obvious. In the phakic group, primary open angle glaucoma had a fairly good response, juvenile type of glaucoma had moderate response and aphakic group poor response to laser therapy [Table - 4]. Wise and Witter' in their study found that aphakic eyes showed less response compared to the phakic eyes. All the four cases with sig­nificant fall in intraocular pressure had a fairly dense pigment in the trabecular meshwork. Out of 3 cases with poor laser response 2 had minimal pigment in the trabecular meshwork. The effect of laser appears to be related to the amount of pigment in the trabecular meshwork. Patients with pseudoexfoliation and glaucoma who have dense pigment in trabecular meshwork require to be compared with patients with minimal pigment to confirm this relationship.

The mechanism of effect of laser therapy ap­pears to be an increase in the trabecular out­ flow.[3],[4]

Small scattered synechiae were observed in two cases in this study. Schwarts et a1 [3] had an incidence of 29% in their series. These synechiae are related to the end point of coagulation and are common with heavier burns. These did non affect the final outcome.


  Summary and conclusion Top


Argon laser therapy in 7 cases of open angle glaucoma uncontrolled with maximal toler­ated medical therapy discussed in detail. In 4 cases the intraocular pressure could be brought down to a level which was considered safe and a filtration surgery could be avoided. In no case was the glaucoma wersened by laser therapy. However, longer follow-up with larger no cases will help us define the place of argon laser therapy in open angle glaucoma in the proper perspective. Laser trabeculoplasty is a resonably effective moderately safe form of therapy in patients with open angle glaucoma.

 
  References Top

1.
Krasnov, M.M. 1973, Amer J. Ophthalmol, 75:674­-678.  Back to cited text no. 1
    
2.
Wise, J.B., Witter, S.L. 1979, Arch. Ophthalmol, 97: AR RAO 319-322.  Back to cited text no. 2
    
3.
Schwartz„A.L., Whitten, M.E., Bleiman, B. Martin D., 1981, Ophthalmolgy 88:203-212.  Back to cited text no. 3
    
4.
Wilensky, J.T., Jampol, L.M. 1981, Ophthalmol 88:213-217.  Back to cited text no. 4
    


    Figures

  [Figure - 1]
 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Material and methods
Observations
Summary and conc...
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed1675    
    Printed67    
    Emailed0    
    PDF Downloaded4    
    Comments [Add]    

Recommend this journal