The medium and long‐term efficacy of primary argon laser trabeculoplasty in avoiding topical medication in open angle glaucoma

To study the medium and long-term efficacy of primary argon laser trabeculoplasty in open angle glaucoma with especial emphasis on avoidance of additional medical therapy. Records of 168 patients with chronic open angle glaucoma or pseudoexfoliation glaucoma who underwent primary argon laser trabeculoplasty between 1987 and 1995 were studied retrospectively (duration of follow-up 1-8 years, mean 4.1 years). Mean baseline intraocular pressure was 28.7 mmHg (range 22-60 mmHg). Need of additional medical therapy was in each case evaluated at the surgeons' discretion, and the results were analysed by survival analysis. The probability of treatment success (no medication required) was for chronic open angle glaucoma 77% after 2 years, 67% after 5 years and 67% after 8 years Corresponding numbers for pseudoexfoliation glaucoma were 80%, 54% and 36%. Prelaser IOP higher than 31 mmHg, pretreatment visual field defect and sparse pigmentation of the trabecular meshwork were independent predictors of failure. Primary argon laser trabeculoplasty gives a long-lasting and favourable effect in chronic open angle glaucoma where 2/3 of the eyes still managed without additional medication for 8 years. The success in pseudoexfoliation glaucoma was even higher the first 3 years, and kept above 50% for 5 years. This makes laser a valuable option as first choice of therapy in glaucoma.