Selective laser trabeculoplasty in pseudophakic and phakic eyes: a prospective study

A retrospective review of selective laser trabeculoplasty outcomes at Lancashire Teaching Hospitals, UK

INTRODUCTION

Selective laser trabeculoplasty has been carried out at Lancashire Teaching Hospitals over the past seven years. This work aimed to review the use of SLT in this Trust. The primary objectives were to establish the efficacy of SLT in reducing intraocular pressure, to analyse how prior treatment with different topical medications can influence SLT outcomes and to analyse the outcomes in revisionary patients.

METHOD

We conducted a retrospective review of 288 eyes, with a known history of glaucoma or ocular hypertension and who underwent initial SLT laser treatment between October 2018 and January 2020. SLT was performed on known glaucoma and treatment naïve patients where IOP control was deemed sub-optimal. All patient data was fully anonymised.

RESULTS

We found that SLT was effective in lowering IOP. Around two-thirds of the eyes (181/280, 65%) achieved a reduction in IOP of 10% or more. Just under half (127/280, 45%) achieved a reduction of 20% or more. For a pre-SLT IOP of 14.6 mmHg, we found that no mean change in IOP is expected, and for each 1 mmHg by which the pre-SLT IOP exceeds this threshold, the mean reduction in IOP is expected to be 0.61 mmHg. We also found that combination therapies of PGA plus aqueous suppressants gave better outcomes compared with PGA alone. We found that revisionary SLT compared favourably with the first treatment, although first-time outcomes were not a good predictor of success with revisionary SLT.

CONCLUSION

Primary and revisionary SLT has been shown to be effective across the cohort of patients in this study.

Comparison of Outcomes for Laser Trabeculoplasty after Kahook Dual Blade Goniotomy Versus in Goniotomy-Naive Eyes

Introduction

This was a comparison of laser trabeculoplasty (LTP) outcomes in eyes with prior Kahook Dual Blade (KDB) goniotomy versus in goniotomy-naive control eyes.

Methods

This was a retrospective matched comparative case series. We identified a cohort of patients undergoing LTP between February 2017 and July 2020 at University of Missouri. Patients were grouped by history of KDB goniotomy versus goniotomy-naivety as a control group. Inclusion criteria included age at least 18 years, minimum of 6 months follow-up after LTP, and minimum period of 6 months between KDB goniotomy and LTP. All KDB procedures were combined with uncomplicated phacoemulsification. Patients who had any additional intraocular pressure (IOP)-lowering procedures between KDB goniotomy and LTP were excluded. Patients in the control group received a single LTP procedure.

Primary outcome consisted of the comparison of LTP success, defined as IOP reduction of at least 20% or reduction of glaucoma medications from pre-LTP baseline. Secondary outcomes included IOP and medication reduction from pre-LTP baseline.

Results

Twenty-one eyes of 19 patients with history of KDB goniotomy and 42 eyes of 36 control patients without previous angle or laser procedures were included. Baseline characteristics including age, gender, ethnicity, type and severity of glaucoma, baseline IOP, and baseline medications were matched between groups. The LTP success rate was higher in the control group, but was not statistically significant (64% vs 57%, p = 0.58). IOP reduction was only significant in the control eyes (2.50 ± 4.0 mmHg, p = 0.01 vs 2.35 ± 4.7 mmHg, p = 0.08). The number of glaucoma medications was not significantly reduced in either group.

Conclusion

LTP may have a limited IOP- and medication-lowering effect in eyes with a history of KDB goniotomy compared to goniotomy-naive eyes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40123-021-00378-7.

Comparison of Treatment Outcomes of Selective Laser Trabeculoplasty for Primary Open-Angle Glaucoma and Pseudophakic Primary Angle-Closure Glaucoma Receiving Maximal Medical Therapy

Selective laser trabeculoplasty (SLT) is a useful treatment for intraocular pressure (IOP) control. However, there are only a few reports which compare the outcomes of SLT between primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). We compared the efficacy of SLT for patients with PACG following phacoemulsification with POAG receiving maximal medical therapy (MMT). Consecutive glaucoma patients followed up for at least 1 year after SLT were retrospectively evaluated and IOP reductions at 6 months and 12 months were analyzed. Seventy-six patients were included in the analyses. The baseline IOPs in the POAG and PACG group were 18.5 ± 3.3 mmHg and 16.9 ± 2.5 mmHg, respectively, with 2.8 ± 0.9 and 2.7 ± 0.8 types of IOP lowering medication. The average IOP at the 6-month and 12-month follow-up after SLT was significantly decreased and comparable in both the POAG and PACG groups. For those with a low baseline IOP, the effect of SLT on IOP reduction at 12 months was significantly better in the PACG than in the POAG group (p = 0.003). IOP reduction at 6 and 12 months after SLT was significantly greater in those with a high baseline IOP than those with a low baseline IOP (p < 0.0065). In summary, the one-year efficacy of SLT was equivalent in POAG and pseudophakic PACG patients receiving MMT; however, SLT was more effective in eyes with PACG than eyes with POAG when focusing on those with a lower baseline IOP.