Repeatability of selective laser trabeculoplasty for open-angle glaucoma

Abstract

BackgroundTo analyze the results of repeat selective laser trabeculoplasty (SLT).MethodsInclusion criteria: participants with primary or secondary open-angle glaucoma (excluding uveitic) who had undergone SLT 360° (SLT 1) with diminution of response over time followed by repeat SLT 360° (SLT 2). Six months of follow-up were required and at least 6 months in between SLT 1 and 2. The main outcome measures were IOP reduction at 6 and 12 months and a comparison of the response between SLT 1 and 2.ResultsOne hundred thirty-seven patients met the inclusion criteria. If only one eye had repeat treatment, that eye was chosen; if both eyes qualified, one was chosen at random. The baseline intraocular pressure (IOP) for SLT 1 = 20.3+/− 5.2 mmHg and SLT 2 = 19.4 +/− 5.0 was reduced to 16.4 +/− 3.9 and 16.7 +/− 4.7 at 1 year, respectively (p < .001). Medication use was not significantly changed, and was 2.2 +/− 1.2 at baseline for SLT 1 and 2.1 +/− 1.3 for SLT 2, and at 1 year was 1.9 +/− 1.3 and 2.2 +/− 1.2, respectively. A subanalysis of 62 patients matched for equivalent baselines showed a baseline IOP = 18.7 +/− 3.8 for SLT 1 and 18.7 +/− 3.5 for SLT 2, reduced to 16.0 +/− 4.3 and 15.3 +/− 3.8 at 1 year (p < .001).ConclusionRepeat SLT laser (360-degree treatment, followed by a loss of effect over time, then a second 360-degree treatment) in this population resulted in IOP lowering similar to that of the initial treatment.

Selective laser trabeculoplasty as replacement therapy in medically controlled glaucoma patients

“…Several studies have already suggested that SLT is repeatable (Lai et al 2004;Hong et al 2009;Ayala et al 2011;Bovell et al 2011). Intraocular pressure (IOP) lowering effect after repeat SLT has been shown to be similar to that of the initial SLT (Francis et al 2016;Phillis & Bourke 2016;Polat et al 2016). In our study, 10 eyes (6.9%) needed a retreatment after a mean of 13.7 months.…”

Efficacy of Repeat Selective Laser Trabeculoplasty in Medication-Naive Open-Angle Glaucoma and Ocular Hypertension during the LiGHT Trial

“…Repeatability of SLT has been studied and considered feasible in suitable patients requiring further IOP reduction. [7][8][9][10][11][12][13][14] However, many of these studies are retrospective and limited by small sample sizes and lack predefined retreatment criteria. In addition, in all but 1 of these studies, 13 SLT was used as an adjunctive treatment in patients already receiving topical IOP-lowering treatment.…”

Re: Hutnik et al.: Selective laser trabeculoplasty versus argon laser trabeculoplasty in glaucoma patients treated previously with 360° selective laser trabeculoplasty: a randomized, single-blind, equivalence clinical trial (Ophthalmology. 2019;126:223–232)

“…Third, the authors did not mention the time interval between the primary SLT and the repeat SLT/ALT. Francis et al 4 found that a shorter time period between the initial and repeat SLT resulted in statistically significant higher success rates. Therefore, we feel that the authors should have mentioned the time interval between the primary SLT and repeat SLT/ALT while assessing the effectiveness of repeat trabeculoplasty.…”