Primary argon laser trabeculoplasty vs. pilocarpine. Short-term effects

Abstract

This is a prospective study of 82 newly discovered patients with simplex or capsular glaucoma from two centres, collected between 1984 and 1989 and selected at random for primary treatment by either laser or pilocarpine. Preliminary two-year follow-up shows that primary laser treatment gives a significantly higher number of patients where the intraocular pressure is successfully controlled. Primary argon laser trabeculoplasty has been carried out in 40 patients. The first treatment was given to either the upper or to the lower half of the trabecular meshwork. In the second treatment after one month the other half was treated. In both groups the first treatment gave the highest pressure reduction. The somewhat higher pressure reduction after upper treatment versus lower was insignificant. The degree of trabecular pigmentation did not influence the two month follow-up result, neither did the type of glaucoma. Of the eyes treated with laser, peripheral anterior synechiae could be seen in 18%. Acute intraocular pressure rises greater than 5 mmHg occurred in 21% of the eyes after the first treatment and in 37% after the second treatment. Pressure rises greater than 10 mmHg occurred in 5% after the first and in 10% after the second treatment. No pressure-lowering substances were given. Considering that 16% of the eyes had an intraocular pressure that was higher than baseline pressure even 6 h after either first or second treatment, it is recommended that a pressure-lowering medication on the day of treatment should be administered.