A Review of Selective Laser Trabeculoplasty: “The Hype Is Real”

Šarenac, Tomislav; Turkanović, Anela Bečić; Ferme, Peter; Gračner, Tomaž

doi:10.3390/jcm11133879

Cited by 10 publications

(19 citation statements)

References 122 publications

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“…Recent research has underscored the safety and effectiveness of SLT as an initial treatment option for glaucoma [ 29 , 30 ]. The European Glaucoma Society now recognizes SLT as either a primary or supplementary treatment for open-angle glaucoma and ocular hypertension, highlighting its clinical importance [ 31 , 32 ]. In Australia, while glaucoma medication prescriptions reached their highest in 2015, there was a subsequent decrease of 14.9% by 2017 [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Estimation of Topical Glaucoma Medication Over-Prescription and Its Associated Factors

Takao,

Ichitani,

Tanito

2023

JCM

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This study aims to report the disparity between the ideal and actual quantities of eyedrops prescribed to individual glaucoma patients. This retrospective observational study included 676 patients receiving treatment with antiglaucoma topical medication(s) in at least one eye. These patients had follow-up appointments scheduled at mean intervals of 3.4 ± 1.4 months and were actively using antiglaucoma medication. The mean age was 70.4 ± 11.9 years, with 372 (55%) being male. The over-prescription volume was 1.4 ± 1.7 bottles per month for each medication when prescribed for both eyes. Multiple regression analysis revealed that older age (p = 0.03), hyperopic refractive error (p < 0.0001), and the use of multiple medications (p = 0.03) were associated with a larger over-prescription volume, while the use of unit-dose medication only (p < 0.0001) was associated with a smaller over-prescription volume. Factors such as sex, Mini-Cog cognitive function score, best-corrected visual acuity, intraocular pressure, glaucoma type, and a history of cataract surgery were not significantly associated. This study revealed a significant over-prescription of eyedrops for glaucoma patients, with actual prescriptions often exceeding the theoretically ideal amount by 2.4 times, influenced by factors like age and the format of prescriptions, where unit-dose eyedrops show promise in reducing excess.

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Section: Discussionmentioning

confidence: 99%

Estimation of Topical Glaucoma Medication Over-Prescription and Its Associated Factors

Takao,

Ichitani,

Tanito

2023

JCM

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“…Nuestro estudio demostró una reducción estadísticamente significativa de los valores de PIO, tanto a los 6 como a los 12 meses, alcanzando reducciones promedio de un 13 y un 15% respectivamente (p < 0.0001 y p < 0.0002). Estas reducciones estarían dentro de los valores publicados en un reciente metaanálisis, en donde se describen series con descensos que van desde un 6.9 a un 35% a los 12 o más meses de seguimiento [7][8][9][10][11] .…”

Section: Discussionunclassified

“…La SLT ha demostrado ser muy efectiva y con pocos efectos adversos, por lo que es una alternativa terapéutica inicial y que permite retrasar y/o reemplazar el tratamiento con colirios en promedio de 3 a 3.5 años 5 . Especial utilidad tiene en pacientes que no desean o no pueden usar gotas o en aquellos en los que la adherencia al tratamiento es el principal factor de riesgo para la progresión [4][5][6][7] . Además se puede repetir en pacientes que previamente hayan respondido, prolongando por más tiempo su efectividad 5 .…”

Section: Introductionunclassified

“…Además se puede repetir en pacientes que previamente hayan respondido, prolongando por más tiempo su efectividad 5 . Sin embargo, a pesar de la excelente respuesta que puede tener en muchos pacientes, existe una alta variabilidad en los resultados publicados, desde el 60 hasta el 90% de efectividad 7,8 . Por este motivo, resulta importante determinar aquellos factores que incidan en la respuesta clínica.…”

Section: Introductionunclassified

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Efectividad de la trabeculoplastia selectiva láser en pacientes chilenos

Díez-Lagos¹,

Opazo-Bernal²,

Bilbao-Robertson³

et al. 2022

IRIS

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ocular (HTO) y del glaucoma primario de ángulo abierto en pacientes chilenos. Materiales y métodos: Estudio descriptivo, observacional retrospectivo de análisis de casos de HTO y glaucoma primario de ángulo abierto (GPAA). Se evaluó el porcentaje de disminución de la presión intraocular (PIO) y el éxito del tratamiento a los 6 y 12 meses, definido como una disminución de al menos un 20% en la PIO basal, y también el número de medicamentos utilizados. Resultados: Se analizaron 50 pacientes con seguimiento a 6 y 12 meses. La edad promedio fue 62 años. La PIO promedio pretratamiento fue 19 ± 5.2 mmHg, logrando a los 6 y 12 meses de seguimiento una disminución promedio del 13 y 15% respectivamente (p < 0.0001 y p < 0.0002). El 46% de los pacientes alcanzó el éxito a los 6 y 12 meses. Se observó una correlación significativa entre la PIO previa y el porcentaje de disminución (r: 0.4; p = 0.005) y también entre el porcentaje de disminución y la desviación media del campo visual pretratamiento (r: 0.4; p = 0.01). No existieron complicaciones. Conclusión: Este estudio confirma que la SLT es una terapia efectiva y segura, como terapia inicial o coadyuvante, para el descenso de los niveles de PIO en pacientes con HTO o GPAA en la población chilena.Palabras clave: Trabeculoplastia láser selectiva. Glaucoma primario de ángulo abierto. PIO. Tonómetro de aplanación de Goldmann.

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“…A parameter \begin{document}\gamma\end{document} is defined as post-SLT divided by pre-SLT trabecular outflow facility (i.e., the factor by which trabecular outflow facility increases following the procedure), which is estimated to be 50% based on previous clinical data [ 15 , 16 ]. It should be noted that the rationale behind increasing the trabecular outflow facility is the fact that the mechanism by which SLT lowers IOP is based on the principle of selective photothermolysis of pigmented cells of the trabecular meshwork targets without causing thermal damage to adjunctive structures [ 3 , 17 ]. Based on its mechanism, it may also be reasonable to assume that SLT does not affect any other parameters apart from \begin{document}C_o\end{document} .…”

Section: Methodsmentioning

confidence: 99%

Identifying Baseline Predictors of Selective Laser Trabeculoplasty Effectiveness: An Alternative Mathematical Approach

Dendumrongsup

2024

Cureus

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Background: Selective laser trabeculoplasty (SLT) emerges as a first-line treatment for newly diagnosed open-angle glaucoma and ocular hypertension. However, the interindividual response to SLT considerably varied. Large-scale clinical investigations concerning predictive factors for SLT effectiveness are limited. This study aimed to identify baseline predictors of the percentage intraocular pressure (IOP)-lowering effectiveness of SLT using an alternative mathematical approach. Methods: Mathematical equations of IOP under the steady state of aqueous humour flow were formulated. The conclusive equation integrates physiological variables, including trabecular outflow facility, uveoscleral outflow fraction, plasma protein concentration, albumin/globulin ratio, mean arterial pressure, episcleral venous pressure, and plasma osmolarity. The equation was employed to estimate the percentage of IOP reduction following SLT and subsequently subjected to global sensitivity analysis to determine significant predictors of the IOP-lowering effect of SLT using the Monte Carlo simulation of 8,192 samples. Results: In the current model, a 50% improvement in the trabecular outflow facility impacted by SLT is associated with a mean percentage IOP reduction of 16.6%. Lower baseline trabecular outflow facilities were the strongest predictors, showing a correlation with greater effectiveness of SLT in terms of percentage of IOP reduction. The second most influential factor includes baseline uveoscleral outflow fraction, followed by baseline episcleral venous pressure. Specifically, lower baseline uveoscleral outflow fraction and episcleral venous pressure were found to be correlated with increased effectiveness of SLT. Baseline levels of plasma protein concentration, albumin/globulin ratio, mean arterial pressure, and plasma osmolarity have minimal impact on SLT success or failure. Conclusion: This study identifies baseline trabecular outflow facilities as the strongest predictor of SLT effectiveness. The results suggested that pre-SLT medical treatment that augments uveoscleral outflow and/or trabecular outflow facilities could compromise the effectiveness of subsequent SLT in terms of percentage IOP reduction compared to those who never received pre-SLT medication.

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A Review of Selective Laser Trabeculoplasty: “The Hype Is Real”

Cited by 10 publications

References 122 publications

Estimation of Topical Glaucoma Medication Over-Prescription and Its Associated Factors

Estimation of Topical Glaucoma Medication Over-Prescription and Its Associated Factors

Efectividad de la trabeculoplastia selectiva láser en pacientes chilenos

Identifying Baseline Predictors of Selective Laser Trabeculoplasty Effectiveness: An Alternative Mathematical Approach

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