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Fewer medications prior to SLT improve chance of success
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One-year efficacy of selective laser trabeculoplasty in controlling intraocular pressure was limited in patients with maximal-tolerable medical therapy, according to a study.
Cases with primary open-angle glaucoma (POAG), moderate IOP and fewer medications had a higher chance of success, Atsuya Miki, MD, PhD, and researchers reported in the Journal of Glaucoma.
The retrospective review included the medical records of 78 consecutive Japanese subjects with glaucoma who underwent selective laser trabeculoplasty (SLT) with at least 1-year follow-up.
In total, 105 eyes of 78 cases were treated with SLT in the study period. About half of the eyes had POAG or normal-tension glaucoma (NTG), 23 had exfoliation glaucoma (XFG), and the remaining cases had open-angle glaucoma that was secondary to steroid (SOAG), previous uveitis and vitrectomy. Average baseline IOP was 23.9 mm Hg, and patients took an average of 3.4 IOP-lowering medications.
It was determined that 41 eyes (54.7%) failed SLT due to subsequent incisional glaucoma surgery in 35 eyes (85.4%), inability to control IOP in five eyes (12.2%) and repeat SLT in one eye (2.4%).
SLT was deemed successful in 61.1% of the POAG (including NTG) group, 29.3% of the XFG group and 15.4% of the SOAG group, according to the study.
At 1 year, cumulative probability of failure was 85.8%. By group, the success rate was 21.7% in the POAG group, 14.5% in the XFG group and 7.7% in the SOAG group.
The average number of IOP-lowering medications in the successful eyes was 3.4 at 1 month, 3.4 at 3 months, 3.4 at 6 months and 3.1 at 1 year after treatment.
The researchers determined that diagnosis of SOAG, higher preoperative IOP and larger number of preoperative medications were significantly predictive of treatment failure.
“It is crucial to carefully select cases taking into account baseline prognostic factors to maximize the effect of treatment when considering for SLT for case under maximal-tolerable medical therapy,” the researchers concluded. – by Abigail Sutton
Disclosure: The researchers reported no relevant financial disclosures.
Perspective
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Scott Anthony, OD, FAAO
Primary glaucoma care using medical therapy is often an effective strategy for reaching a patient’s targeted IOP range. Although laser applied to the trabecular meshwork can be a first-line glaucoma treatment, most clinicians and patients opt for medical therapy at the time of diagnosis.
However, side effects and waning efficacy of medical therapy may eventually require further nonmedical intervention. Unfortunately, this study suggests that selective laser trabeculoplasty (SLT), considered to be a safe and effective means of lowering IOP, has spotty success for those patients who have exhausted medical therapies. For patients whose IOP and disease course is not controlled with maximal-tolerated medical therapy, clinicians cannot always rely on SLT to bail them out.
It is hoped that new emerging microinvasive/minimally invasive glaucoma surgeries (MIGS) and new trans-scleral cyclophotocoagulation devices will help bridge the gap between medical glaucoma management and more invasive surgeries such as trabeculectomy.
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