Effect of prior cataract surgery on the long-term outcome of selective laser trabeculoplasty

Abstract

Objective:To determine if pseudophakia affects selective laser trabeculoplasty (SLT) intraocular pressure (IOP) lowering effect.Methods:A retrospective chart review was performed on 94 eyes of 75 consecutive patients who underwent SLT as primary treatment for ocular hypertension and primary open-angle glaucoma between 2002 and 2005 and completed at least 30 months follow up. Patients were excluded if they required additional glaucoma medications, laser, or ocular surgery during the follow-up period. Patients were categorized as phakics or pseudophakics. Independent-samples t-test was performed to compare the mean percentage of IOP reduction at 3, 6, 12, 18, and 30 months after SLT between the phakic and pseudophakic groups.Results:Seventy-six phakic and 18 pseudophakic eyes were included. IOP reduction in phakic group was 27.4% (2 week), 29.8% (3 months), 27.7% (9 months), 27.4% at (12 months) and 27.3% at (30 months). In pseudophakic patients, the mean IOP reduction was 19.8% (2 weeks), 26.5% (3 months), 23.2% (9 months), 22.5% (12 months), and 25.9% (30 months). An independent-sample t-test compared the percentage of IOP reduction between the phakic and pseudophakic groups and revealed higher percentage of IOP reduction in the phakic group at 2 weeks by 7.6% (P = 0.01). P value for difference was 0.34 (3 months), 0.25 (6 months), 0.18 (9 months), 0.12 (12 months), 0.36 (18 months), and 0.7 (30 months) after SLT.Conclusions:SLT response was delayed in pseudophakic compared to phakic patients, while the long-term effectiveness of SLT is the same in both groups.

The efficacy of selective laser trabeculoplasty versus argon laser trabeculoplasty in pseudophakic glaucoma patients

“…Their conclusion was that the response to SLT treatment was delayed in the pseudophakic compared to the phakic patients, while the long-term effectiveness of SLT was the same in both groups. It is unclear why SLT may be more effective in pseudophakic patients, but, as suggested by those authors,24 it is plausible that clear corneal phacoemulsification and SLT may share a common pathway involving inflammation, prostaglandin release, and interleukin-1α release. Therefore, the IOP response to SLT may be different in pseudophakic eyes compared to phakic eyes due to partial or complete activation of pathways common to the SLT response and to the clear cornea phacoemulsification mediated IOP-lowering effect in those patients.…”

“…A recent study by Shazly et al24 evaluated the IOP-lowering effect of SLT as primary treatment in POAG or OHT phakic patients to POAG or OHT pseudophakic patients in up to 30 months of follow-up. They found the greatest reduction in IOP at 3 months posttreatment, which is what we found in our current study.…”

Same-Day Bilateral Glaucoma Laser Treatments in Ontario

“…Considering that the IOP-lowering response to SLT will typically occur in 4 weeks, and up to 8 to 12 weeks in pseudophakic patients, sequential therapy would require longer than a standard 1-to 2-week follow-up to gauge effectiveness before treating the second eye. 22 We attribute the increase in volume of LT, both unilateral and same-day bilateral, to the introduction of SLT in 2001. 1 Despite an increase in the number of LPI, the rate of same-day bilateral LPI stabilized from 2006 to 2013.…”

Effect of Central Corneal Thickness on the Long-Term Outcome of Selective Laser Trabeculoplasty as Primary Treatment for Ocular Hypertension and Primary Open-Angle Glaucoma

“…Prior cataract surgery has been found to have a negative impact on the outcome of SLT. 13 CCT may also be a risk factor for the severity of glaucomatous disease. According to the Ocular Hypertension Treatment Study, 14 European Glaucoma Prevention Study, 15 and the Barbados Eye Study, 16 a thin CCT is an independent risk factor for the development of glaucoma.…”