gms | German Medical Science

104. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft e. V. (DOG)

21. - 24.09.2006, Berlin

Selective laser trabeculoplasty complicated by intraocular pressure elevation and uveitic reaction in a patient with pigmentary glaucoma – a case report

Meeting Abstract

  • K. Marešová - Department of Ophthalmology, University Teaching Hospital, Palacky University, Olomouc, Czech Republic
  • P. Šebesta - Department of Ophthalmology, Central Military Hospital and University Teaching Hospital, Charles University, Prague, Czech Republic
  • P. Výborný - Department of Ophthalmology, Central Military Hospital and University Teaching Hospital, Charles University, Prague, Czech Republic
  • Š. Mohlerová - Department of Ophthalmology, University Teaching Hospital, Palacky University, Olomouc, Czech Republic
  • J. Pašta - Department of Ophthalmology, Central Military Hospital and University Teaching Hospital, Charles University, Prague, Czech Republic

Deutsche Ophthalmologische Gesellschaft e.V.. 104. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft (DOG). Berlin, 21.-24.09.2006. Düsseldorf, Köln: German Medical Science; 2006. Doc06dogP055

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Veröffentlicht: 18. September 2006

© 2006 Marešová et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective

To report and assess the complication and outcome of intraocular pressure (IOP) elevations after selective laser trabeculoplasty (SLT) in a patient with pigmentary glaucoma.

Methods

Analysis and evaluation of medical records of a patient who underwent unilateral SLT treatment complicated by uveitic reaction and IOP elevation. The efficacy of this treatment was shown in multiple studies and the reported complication were minimal and transient in nature. However Harasymowycz et al. was first to report SLT treatment complicated by intraocular pressure elevation in eyes with heavily pigmented trabecular meshworks.

Results

We present a 41 year old male patient who had diagnosed pigmentary glaucoma. Because his glaucoma was not compensated on medical therapy and the IOP reached up to 25 mmHg he underwent 360° SLT treatment in his right eye in April 2005. The IOP lowering medical therapy was not reduced. He presented with IOP up to 35 mmHg and marked uveitic reaction after three days. He was treated with anti-inflammatory agents and received maximally tolerated IOP lowering conservative therapy. However the IOP elevation did not respond to the medical therapy and trabeculectomy was carried out one month later. The procedure failed and uncontrolled IOP elevation necessitated retrabeculectomy with MMC. The IOP settled down afterwards and remained controlled. By the last visit (February 2006) the IOP in his right eye was 18 mmHg and the visual acuity 0.66 with myopic correction.

Conclusions

SLT procedure is a safe IOP lowering method in glaucoma patients. The adverse effects of treatment, if present, are mild and transient. The physicians should be aware of possible marked reaction in patients with pigmentary glaucoma and heavily pigmented trabecular meshworks. We do not know the exact mechanism of postlaser IOP elevation unfortunately but we may speculate that a marked trabeculitis and further compromised trabecular meshwork function could cause the IOP elevation. As suggested by Harasymowycz et al., modifying the SLT settings (using fewer pulses, lower energy) may decrease the risk of adverse reactions in such a patient.