Surgical Management of Pseudoexfoliation Glaucoma

Evaluating selective laser trabeculoplasty versus argon laser trabeculoplasty in pseudoexfoliation glaucoma patients

“…1,4,6,11,12 Therefore, because ALT emits greater thermal energy, it may induce greater tissue contraction and aqueous outflow. 13,14 The comparable efficacy of the laser trabeculoplasty modalities in POAG has been well established by studies, including a retrospective analysis by Juzych et al who followed 154 ALT and 41 SLT eyes for a maximum of 5 years and found no significant difference in IOP reduction or long-term success rates. 12 Likewise, a metaanalysis of 6 RCTs by Wang et al comparing ALT and SLT revealed no significant difference in postoperative IOP reduction from 1 hour to 5 years.…”

Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma: A Review of the Literature with Updates on Surgical Management

“…More recent studies suggest similar outcomes of trabeculectomy in patients affected by PEG with respect to those affected by POAG in terms of IOP reduction, postoperative medical treatment, and surgical complications [ 102 , 103 ]. Today, antifibrotic agents such as mitomycin C or 5-fluorouracil are commonly used to enhance the success rate of this procedure [ 99 ], similar to results obtained in POAG [ 104 ].…”

“…Trabeculectomy still represents the most frequent incisional procedure in the surgical management of PEG patients with advanced glaucomatous disease or when appropriate medical or laser treatment fails in controlling IOP levels [ 99 ]. It has been widely described that patients with PEG present a greater risk to develop surgical complications, due to the presence of zonular weakness or blood-ocular barrier dysfunction [ 100 ].…”

“…Therefore, surgical removal of this obstruction may lead to successful decrease of IOP. The angle-based procedures represent a group of techniques that seek to recover the natural aqueous outflow channels minimizing complications occurring in filtering surgical procedures, especially bleb-related issues [ 99 ].…”

“…The most commonly performed angle-based procedures are ab-interno trabeculectomy and trabecular aspiration. As nonpenetrating techniques, besides the reduction of postoperative complications after filtering surgery, these procedures have the advantage of preserving the conjunctiva so that penetrating surgery or aqueous shunt device implantation may be performed in the future [ 99 ].…”