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Glaucoma Diode Laser Trabeculoplasty in Patients with Pseudoexfoliative Glaucoma Nikola Babi ć , 1 Aleksandar Miljković 2 and Veljko Andrei ć 3 1. Ophthalmologist, Head, Glaucoma Department, Eye Clinic, Clinical Center of Vojvodina, Vojvodina, Serbia and Assistant Professor, Medical Faculty University of Novi Sad, Serbia, 2. Ophthalmologist, Eye Clinic, Clinical Center of Vojvodina, Vojvodina, Serbia, and Teaching Assistant in Ophthalmology, Medical Faculty University of Novi Sad, Serbia, 3. Ophthalmologist, Eye Clinic, Clinical Center of Vojvodina, Vojvodina, Serbia Abstract Aim: A prospective study was carried out to examine the efficacy of diode laser trabeculoplasty (DLT) in the treatment of pseudoexfoliative glaucoma (XFG). Material and Methods: Laser trabeculoplasty was performed by Zeiss VISULAS 532s diode pumped solid state laser on 69 eyes of 40 patients with XFG and primary open-angle glaucoma. Power of 600–1,200 mW was used, with a spot size of 100 microns and a pulse of 0.10 second. One hour before DLT brimonidine 0.1 % was administered and during seven days after the treatment Dexamethasone 1 % was administered. All patients underwent complete ophthalmic evaluation before and at intervals after treatment (seven days, one, three and six months and one year postoperatively). During the follow-up period, patients were treated with the same topical anti-glaucoma medicaments as before diode laser trabeculoplasty. Results: Before treatment in XFG patients mean intraocular pressure (IOP) was 23.7±2.6 mmHg and seven days after DLT it was 16.8 ± 2.1 mmHg that is 26.9 % decrease from the baseline, on day 30 it was 14.3 ± 2.2 mmHg which is 38.3 % decrease from the baseline, after 3 months 13.9 ± 2.4 mmHg (39.0 % decrease from the baseline), after six months 13.8 ± 2.7 mmHg or 39.9 % decrease from the baseline and after one year 15.1 ± 3.1 mmHg that makes 36.3 % decrease from the baseline. No side effects (either objective or subjective) were present in examined patients. Conclusions: There is statistically significant difference between IOP before and after diode laser trabeculoplasty, so it is concluded that diode laser trabeculoplasty is an effective mode of treatment for eyes with open-angle glaucoma especially in patients with XFG. Keywords Diode laser trabeculoplasty, pseudexfoliative glaucoma, primary open angle glaucoma Disclosure: The authors have no conflicts of interest to declare. Received: 23 October 2012 Accepted: 20 November 2012 Citation: European Ophthalmic Review, 2013;7(1):14–6 Correspondence: Nikola Babi ć , Eye Clinic, Clinical Center of Vojvodina, Hajduk Veljkova 1-7, 21000 Novi Sad, Serbia. E: nikobab@sbb.rs Primary open-angle glaucoma (POAG) is a chronic and usually bilateral disease. It can vary in time and onset and is characterised by abnormalities in the visual field that are caused by loss of optic nerve fibres. Open anterior chamber angle is characteristic in this disease. Typical form of secondary open-angle glaucoma is pseudoexfoliative glaucoma (XFG). 1 Here, we can find deposits of whitish, fibril material in the anterior segment and chamber angle. It can be aggressive. We can usually find pseudoexfoliation material on the surface of lens, but also in the conjunctiva, wall of a short posterior ciliary artery, in eyelid skin, 2 as well as in other extraocular structures (extraocular rectus and oblique muscles, vortex veins and optic nerve sheaths). When treating POAG our primary goal is to normalise intraocular pressure (IOP) and to maintain it this way. It can be achieved by using laser trabeculoplasty that is an effective painless method of lowering IOP. It is known that 56–80  % of patients have 25–30  % lower IOP in period of two years after trabeculopasty in comparison to IOP before treatment. 3–5 After 3–5 years a fading effect on IOP is seen in some patients. 6–8 When comparing eyes treated with trabeculoplasty and those treated with topical medication, it is seen that eyes treated with trabeculoplasty have better results regarding IOP, visual field and optic disc status. 9 Information provided from Advanced glaucoma intervention study (AGIS) publications show that in African Americans when maximum medical therapy have no results the first choice of following procedures is argon laser trabeculoplasty (ALT) and for 14 Caucasians it is trabeculotomy. 10 If laser trabeculoplasty is performed in patients with PAOG together with topical medication there is 50 % lower risk of progression. 11 Success of laser trabeculoplasty in PAOG is 77 % after two years and 67 % after both five and eight years. In XFG, success after two, five and eight years is 80, 54 and 36 %, respectively. 12,13 Laser Trabeculoplasty Laser trabeculoplasty is used in treatment of POAG, XFG and pigmentary glaucoma. It is not used in treatment of angle-closure glaucoma, secondary glaucoma, juvenile glaucoma and in patients who are under 40 years of age if they do not suffer from pigmentary or XFG. There are several types of laser used for trabeculoplasty: argon laser trabeculoplasty (ALT), diode laser trabeculopasty (DLT), Krypton laser trabeculoplasty and Q-switched Nd:YAG which is also known as selective laser trabeculoplasty (SLT). Regarding ALT we can find three theories explaining the way it works. First of them is Wise and Witter and it is purely mechanical. 14 It says that, at the site of laser application, there is shrinkage of the meshwork which causes contraction of collagen in trabecular lamellae. It results in reduction of ring diameter and tightening of trabecular meshwork (TM)which together leads to opening of intratrabecular spaces between laser sites. 14–16 According to second theory there is trabecular cell replication and repopulation of the meshwork with fresh trabecular endothelial cells (these cells normally do not have a potential to divide). 15 It is presumed that these new cells have more normal physiological function. 17 The third theory uses the release of cytokines at the site of laser application in its explanation. This induces © Touch ME dical ME dia 2013