Panmacular subthreshold diode micropulse laser (SDM) as neuroprotective therapy in primary open-angle glaucoma
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Purpose: To determine the effect of panmacular subthreshold diode micropulse laser (SDM) on optic nerve function in eyes with glaucomatous optic neuropathy (GON).
Method: A medical records review identified all patients with advanced primary open-angle glaucoma (POAG)
evaluated by visually evoked potential (VEP) testing before and after SDM treatment. Additional testing including pattern electroretinography (PERG), and mesopic visual acuity and mesopic visual field testing using Omnifield resolution perimetry (ORP).
Results: 88 eyes of 48 consecutive patients were included for study, 20 male and 28 female, aged 57-94 (average: 79). All patients had GON and visual field loss prior to treatment. Pretreatment, IOPs ranged 6-23 mmHg (average: 13) on 0-3 (average: 1.6) medications. 33 eyes had had prior glaucoma surgery. Snellen visual acuities (VA) ranged 20/15 to count fingers (median 20/60). Prior to treatment, both VEPs and ORPs of all eyes were abnormal. Following SDM, Snellen VA was improved (p = 0.005) and IOP was unchanged. VEP P1 amplitudes (p = 0.001) and mesopic VA and automated perimetry were significantly improved (p < 0.0001, respectively).
Conclusion: Panmacular SDM produced significant improvements in optic nerve function by VEP, PERG, chart VA, mesopic VA, and mesopic automated perimetry. These improvements were achieved without IOP lowering. Further study is indicated to determine if SDM might be neuroprotective and aid the clinical management of glaucoma.
Summary: In an observational retrospective cohort study, panmacular SDM laser was found to significantly
improve VEP amplitudes and automated perimetry in eyes with glaucomatous optic neuropathy.
Glaucoma Research 2018-2020, pp. 283-296 #20
Edited by: John R. Samples and Paul A. Knepper
© Kugler Publications, Amsterdam, The Netherlands
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