Efficacy and safety of first-line or second-line selective laser trabeculoplasty for normal-tension glaucoma: a multicentre cohort study (original) (raw)
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Clinical Ophthalmology, 2011
To compare the pattern of intraocular pressure (IOP) reduction following selective laser trabeculoplasty (SLT) versus argon laser trabeculoplasty (ALT) in open-angle glaucoma (OAG) patients, and to investigate the ability of initial IOP reduction to predict mid-term success. Methods: A prospective, nonrandomized, interventional case series was carried out. Consecutive uncontrolled OAG glaucoma patients underwent SLT or ALT; the same preoperative medical regimen was maintained during follow-up. Data collected included age, type of OAG, pre-and postoperative IOP, number of glaucoma medications, and surgical complications. Post-treatment assessments were scheduled at day 1 and 7 and months 1, 3, and 6. Results: A total of 45 patients (45 eyes) were enrolled [SLT group (n = 25); ALT group (n = 20)]. Groups were similar for age, baseline IOP, and number of glaucoma medications (P $ 0.12). We found no significant differences in mean IOP reduction between SLT (5.1 ± 2.5 mmHg; 26.6%) and ALT (4.4 ± 2.8 mmHg; 22.8%) groups at month 6 (P = 0.38). Success rates (IOP # 16 mmHg and IOP reduction 2525%) at last follow-up visit were similar for SLT (72%) and ALT (65%) groups (P = 0.36). Comparing the pattern of IOP reduction (% of IOP reduction at each visit) between groups, we found a greater effect following SLT compared with ALT at day 7 (23.7% ± 13.7% vs 8.1% ± 9.5%; P , 0.001). No significant differences were observed at other time points (P 25 0.32). Additionally, the percentage of IOP reduction at day 7 and at month 6 were significantly correlated in the SLT group (R 2 = 0.36; P , 0.01), but not in the ALT group (P = 0.89). Early postoperative success predicted late success in most SLT cases (82%). No serious complications were observed. Conclusion: Although mid-term results suggest SLT and ALT as effective and equivalent alternatives, a greater initial IOP reduction was observed following SLT. In addition, the initial IOP reduction was a good predictor of mid-term success in patients undergoing SLT, but not ALT.
Prospective Study on the Effect of Selective Laser Trabeculoplasty in Normal Tension Glaucoma
Purpose: Compare the effect of selective laser trabeculoplasty (SLT) in normal tension glaucoma (NTG) patients with its effect in primary open angle and ocular hypertension patients (POAG/OHT), considering both evolution of intraocular pressure (IOP) and mean number of medication. Method: Prospective trial of130patients on glaucoma medication. Patients were offered SLT as a means to diminish medication use. Both eyes of the patient underwent SLT. Laser was performed over 360°, 100 spots, 3nsec, 400 μm. IOP and medication were recorded at 1 hour, 1 week, 1, 3, 6, 12 and 18 months. Results were compared with a control group of patients that remained on medication. Results: IOP changed little after SLT, as the groups were controlled under medication. Nevertheless, SLT was able to achieve additional IOP reduction: 9% and 6% respectively after 12 and 18 months in the NTG group and 19% and 2% respectively in the POAG/OHT group. The use of medication lowered significantly: from a mean of 1.20 in the NTG group to 0.19 and from 1.71 to 0.31 in the POAG/OHT group. This was a significant change compared to the control groups. Mean reduction of medication after SLT was comparable between the NTG and the POAG/OHT group at 1 week, 1 month, 3,6 and 12 months. Conclusions: The efficacy of SLT is not inferior in NTG patients compared to POAG or OHT patients.
Primary Selective Laser Trabeculoplasty for Open-Angle Glaucoma and Ocular Hypertension
Ophthalmology, 2019
Purpose: To report clinical efficacy, predictors of success and safety of primary selective laser trabeculoplasty (SLT) used in treatment-naïve open-angle glaucoma (OAG) or ocular hypertension (OHT) patients. Design: Post-hoc analysis of a multicentre prospective randomized-controlled-trial. Participants: Treatment-naïve OAG or OHT patients. Methods: Patients randomized to SLT or topical medication and treated to pre-defined target IOPs requiring ≥20% IOP reduction from baseline for all disease severity levels. Outcome Measures: Initial ("early") absolute IOP-lowering at 2-months. Achievement of "drop-free disease-control": meeting target IOP without disease progression or need for additional topical medication over 36-months following SLT. Predictors of early absolute IOP-lowering and drop-free "disease-control" after single initial SLT. Frequency of laser-related complications. Results: 611 eyes (195 OHT & 416 OAG) of 355 patients received SLT and 622 eyes (185 OHT & 437 OAG) of 362 patients received topical medication at baseline. Early absolute IOP-lowering following SLT was no different between OHT and OAG eyes (adjusted mean difference =-0.05mmHg; 95% confidence interval (CI)-0.6 to 0.5mmHg; p=0.85). No difference was noted in early absolute IOP-lowering between topical medication and primary SLT (adjusted mean difference =-0.1mmHg; 95% CI,-0.6 to 0.4mmHg; p=0.67). Early absolute IOP-lowering with primary SLT was positively associated with baseline IOP (Coefficient 0.59; 95% CI, 0.54 to 0.64; p<0.001) and negatively with female gender (Coefficient-0.63; 95% CI,-1.23 to-0.02; p=0.04). At 36months, 536 eyes (87.7% of 611 eyes) of 314 patients (88.5% of 355 patients) were available for analysis. 74.6% of eyes (400 eyes) treated with primary SLT achieved drop-free "disease-control" at 36-months; 58.2% (312 eyes) following single SLT. Total SLT power and 2-month IOP were predictors of drop-free "disease-control" at 36-months following single SLT. 6 eyes of 6 patients experienced immediate post-laser IOP spike (>5mmHg from pre-treatment IOP) with 1 eye requiring treatment. Conclusion: Primary SLT achieved comparable early absolute IOP-lowering in OHT vs OAG eyes. Drop-free "disease-control" was achieved in ~75% eyes at 36-months following 1 or 2 SLTs; the majority of these following single SLT. These analyses are exploratory, but support primary SLT to be effective and safe in treatment-naïve OAG and OHT eyes.
Selective Laser Trabeculoplasty in the Treatment of Open-angle Glaucoma
Journal of Glaucoma, 2012
Purpose: To determine the effect of selective laser trabeculoplasty (SLT) on different types of open-angle glaucoma (OAG) in terms of intraocular pressure (IOP). Methods and Materials: In this prospective, nonrandomized, interventional study, patients with OAG, unresponsive to maximum tolerable antiglaucoma medication, were enrolled. One thirty six eyes were studied. Distribution of glaucoma type was 91 primary OAG eyes (POAG, 66.9%), 22 pseudoexfoliative glaucoma (PEX, 16.2%) eyes, and 23 pigmentary glaucoma (PG, 16.9%) eyes. Main outcome measures were IOP and number of antiglaucoma medications used before operation, at 1 day, at 1 week, and at 1 to 18 months after surgery. Using the standard approach 360-degree SLT was done. Results: The mean follow-up was 16.6±4.3 months. The mean preoperative IOP was 22.0±3.7 mm Hg, and reduced to 18.3±3.7 mm Hg at last visit. The overall mean IOP decrease was 3.6±2.6 mm Hg (16.3%) on the last visit compared with before surgery, indicating a reduction of 16.7% in POAG, 16.6% in PEX, and 14.5% in PG. Comparison of IOP values at 6 and 16 months showed an increase of 0.5 and 2.7 mm Hg in total sample and PG group. IOP reduction was significantly less among diabetic patients. Conclusions: SLT resulted in a significant IOP reduction of 16.3% at 16 months after surgery. The level of IOP reduction did not vary in POAG, PEX, and PG groups. A significant increase in IOP was observed in PG group after 6 months. The procedure seemed least effective in diabetic patients.
Objectives: To determine if central corneal thickness influences Intra Ocular Pressure (IOP) lowering response of Selective Laser Trabeculoplasty (SLT) in patients with medically uncontrolled primary open angle glaucoma. Methods: Consecutive patients who received selective laser trabeculoplasty during May 2011 through June 2013 were enrolled in this retrospective chart review study. Information gathered included age, gender, race, central corneal thickness and type of glaucoma. Number of glaucoma medications, visual acuity, and IOP were assessed before and after treatment. Results: Data from 48 patients (77 eyes) were used in the analysis. There were no significant differences in the number of glaucoma medications used or visual acuity before or after treatment. IOP measurements decreased 10.3% over preoperative levels through 18-months from a mean preoperative pressure of 18.4 5.5 to 16.5 4.7 mmHg (P < 0.0005). The mean central corneal thickness was 533.8 38.0 m. The treated eyes were divided into two groups by central corneal thickness: thin (<555m), and thick (>555m). There was no difference in mean IOPs of the groups preoperatively, but during the 18 months follow-up there was a significant mean change in intraocular pressure within the thin group (-2.5 mmHg, 95%CI [-3.8,-1.2], p=0.0002) but not in the thick group (-1.6mmHg, 95% CI [-3.4, +0.2], p=0.08). However, the difference between the central corneal thickness groups was not statistically significant. Conclusions: Selective laser trabeculoplasty was more effective in reducing IOP, when used as an adjunct to medical therapy for glaucoma, in patients with thin central corneal thickness (<555m) than those with thick central corneal thickness (>555m).
Corneal changes after a single session of selective laser trabeculoplasty for open-angle glaucoma
Purpose To investigate the changes in endothelial cell count, central corneal thickness (CCT), and refractive error after a session of selective laser trabeculoplasty (SLT) for open angle glaucoma (OAG). Methods This prospective cohort study recruited 111 eyes of 66 consecutive subjects with OAG. Subjects received SLT to 3601 of the trabecular meshwork. Endothelial cell count, CCT, and spherical equivalent were measured at baseline before SLT as well as at 1 week and 1 month post SLT. A repeated measure nested ANOVA with Tukey's multiple comparison test was performed to compare the outcome measures before and after SLT. Results In 111 eyes of 66 subjects, the mean number of laser applications per treatment was 166.9 ± 41.4 with a mean energy level of 1.0 ± 0.07 mJ. The mean endothelial cell count decreased significantly from 2465.0±334.0 cells/mm 2 at baseline to 2355.0±387.0 cells/mm 2 at 1 week (P ¼ 0.0004) but increased to baseline levels at 1 month post SLT (2424.0 ± 379.4 cells/mm 2 , P ¼ 0.3). The CCT, which decreased from a baseline of 549.4 ± 37.6 to 543.9 ± 40.2 mm at 1 week post SLT (P ¼ 0.02), also returned to the baseline level by 1 month (P ¼ 0.2). The spherical equivalent was static from baseline. A positive correlation was found between total laser energy and CCT at 1 month post treatment (r ¼ 0.3, P ¼ 0.005). Conclusion The transient reductions in endothelial cell count and CCT following SLT returned to baseline levels 1 month after the procedure. Patients undergoing SLT should be aware of the risk of potential corneal changes.
Evaluation of selective laser trabeculoplasty as an intraocular pressure lowering option
Acta Ophthalmologica, 2019
PurposeSelective laser trabeculoplasty (SLT) is one of the many treatment options for lowering intraocular pressure (IOP) in patients with glaucoma. This study aimed to evaluate the effect of SLT.MethodsData were collected from medical records of 289 patients who underwent SLT treatment (180° of trabecular meshwork) during 2014 and 2015 at the Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden. Baseline characteristics and information from a follow‐up within 100 days were also recorded. The study analysed different subtypes of glaucoma with regard to SLT, with a particular focus on exfoliative glaucoma, a common subtype in Sweden. Successful treatment was defined as an IOP lowering effect of >20% with no further changes in treatment. The impact of surgeon's experience on treatment outcome was also analysed.ResultsBoth patients with exfoliative glaucoma and those with primary open‐angle glaucoma showed a reduction in mean IOP; no significant differen...
Clinical Ophthalmology, 2010
Purpose:To evaluate the effect of selective laser trabeculoplasty (SLT) in normal tension glaucoma (NTG) patients.Patients and methods:A retrospective review was performed of NTG patients who had undergone SLT at the Duke University Eye Center between 12/2002 and 7/2005. For each eye of each patient at pre-laser and post-laser time points, the IOP measurements were summarized by mean, standard deviation, and range. Then for each of these descriptive statistics, the differences between pre-laser and post-laser values were obtained. Statistical analysis was performed using a random effects model. Main outcome measures: difference in mean IOP, standard deviation of IOP, and range of IOP.Results:Thirty-one eyes of 18 patients were included for analysis. The average of the mean pre-operative IOP measurements was 14.3 ± 2.6 mmHg compared to 12.2 ± 1.7 mmHg (P < 0.001) post-operatively. The mean pre-operative standard deviation was 1.9 ± 0.9 mmHg compared to 1.0 ± 0.6 mmHg (P = 0.002) post-operatively while the mean IOP range prior to treatment was 4.5 ± 2.5 mmHg compared to 2.5 ± 1.9 mmHg (P = 0.017) after treatment.Conclusion:In this pilot study, SLT was found to lower mean IOP and intervisit IOP variation in NTG patients. Given the importance of IOP variation and its association with glaucoma progression, measurement of IOP variation following treatment with SLT may be considered.
Laser trabeculoplasty in newly diagnosed multi‐treated glaucoma patients
Acta Ophthalmologica, 2020
PurposeTo evaluate the intraocular pressure (IOP)‐lowering effect of laser trabeculoplasty (LTP) in eyes which IOP had been substantially reduced by intensive topical treatment for one week.MethodsPatients with newly diagnosed open‐angle glaucoma were randomized to treatment with three IOP‐lowering substances. One week later, 360° argon or selective LTP was performed. IOP was measured before LTP and at one‐, three‐, six‐ and 12‐month post‐LTP. The patients were part of the Glaucoma Intensive Treatment Study (GITS).ResultsMean IOP (± SD) in 152 eyes of 122 patients was 14.0 (± 3.5) mmHg just before LTP. For every mmHg higher IOP prior to LTP, the IOP was reduced by an additional 0.6 mmHg at 12 months. The IOP was significantly reduced at all follow‐up visits from −2.6 (± 3.1) mmHg at one month to −2.1 (± 3.8) mmHg at 12 months in eyes with pre‐LTP IOP ≥ 15 mmHg, while no significant IOP reduction was seen in eyes with pre‐LTP IOP < 15 mmHg. Older age, argon LTP and male sex were a...
Nigerian Journal of Ophthalmology, 2015
Objective: The objective was to compare the intraocular pressure (IOP) lowering effect of selective laser trabeculoplasty (SLT) as initial and adjunct therapy in primary open angle glaucoma (POAG). Subjects and Methods: Retrospective chart review of POAG patients who had SLT either as initial or adjunct therapy over a period of 1-year. Each patient had SLT done in 360° of the anterior chamber angle. IOP measurement with the Goldmann applanation tonometer was done at baseline, 60 min post procedure, days 1, 7, 30, 90, and 180. Results: Mean baseline IOP was 15.4 ± 3.5 mmHg and 17.5 ± 5.5 mmHg for initial and adjunct, respectively (P = 0.153); not significant. Mean IOP at 90 days was 10.5 ± 1.8 mmHg and 16.2 ± 6.3 mmHg for initial and adjunct, respectively (P = 0.013); statistically significant. Records at 180 days revealed mean IOP of 14.1 ± 3.9 mmHg and 15.7 ± 7.7 mmHg (P = 0.465) for initial and adjunct, respectively; not significant. The maximal mean IOP reduction in both groups w...