Argon laser trabeculoplasty (ALT) for advanced glaucoma: A 12 months follow-up study

Purpose ALT has been used for lowering the intraocular pressure (IOP) for over 25 years. The aim of this study was to investigate the safety and efficacy of ALT in cases of advanced glaucoma unsuitable for surgery due to ocular or systemic conditions. Methods This retrospective observational study had the following inclusion criteria: advanced POAG with uncontrolled IOP, maximum medical treatment, previously failed ALT or filtration surgery and unsuitability for surgical intervention due to ocular or systemic comorbidities. The data collected included: pre- and postoperative number of medications, visual acuity (VA), visual fields mean deviation (VF MD), IOP and adverse events during the study period. All ALT treatments were carried out by the same clinician. Results A total of 40 patients (40 eyes; mean age: 79 years; range 56-92 years) were identified. The number of medications remained unchanged in 75% patients, decreased by 2-4 medications in 12.5% of patients and increased by 1-2 in 12.5% of patients. Mean Log MAR VA (baseline 0.27±SD 0.45; final 0.19±SD 0.3) and the VF MD (baseline -9.17±SD 8.9; final -9.45±SD 9.3) did not change significantly over the 12 months study period (Log MAR p=0.29; VF MD p=0.18). The change in IOP was statistically significant, p=0.00018 (p<0.001), with an average IOP reduction by 18.14% at 12 months. In 76% of patients the mean IOP decreased by 6 mmHg and in 47.5% of patients the final IOP was lower than 16mmHg. No adverse events were observed during the study. Conclusion ALT appeared safe and effective in lowering the IOP in cases of advanced glaucoma unsuitable for surgery.