Laser trabeculoplasty in newly diagnosed multi‐treated glaucoma patients

Abstract

To evaluate the intraocular pressure (IOP)-lowering effect of laser trabeculoplasty (LTP) in eyes which IOP had been substantially reduced by intensive topical treatment for one week. Methods: Patients with newly diagnosed open-angle glaucoma were randomized to treatment with three IOP-lowering substances. One week later, 360°argon or selective LTP was performed. IOP was measured before LTP and at one-, three-, six-and 12-month post-LTP. The patients were part of the Glaucoma Intensive Treatment Study (GITS). Results: Mean IOP (AE SD) in 152 eyes of 122 patients was 14.0 (AE 3.5) mmHg just before LTP. For every mmHg higher IOP prior to LTP, the IOP was reduced by an additional 0.6 mmHg at 12 months. The IOP was significantly reduced at all follow-up visits from À2.6 (AE 3.1) mmHg at one month to À2.1 (AE 3.8) mmHg at 12 months in eyes with pre-LTP IOP ≥ 15 mmHg, while no significant IOP reduction was seen in eyes with pre-LTP IOP < 15 mmHg. Older age, argon LTP and male sex were associated with larger IOP reduction after 12 months, whereas presence of exfoliation syndrome was associated with a smaller IOP reduction. No severe complications were reported. Conclusion: Success of LTP was highly dependent on the IOP level prior to LTP treatment. A sustained significant IOP reduction was seen in eyes with pre-LTP IOP ≥ 15 mmHg whereas no such effect was seen in eyes with pre-LTP IOP < 15 mmHg. Thus, LTP can be considered in eyes with multi-treatment when target pressure of < 15 mmHg is not achieved.

Comparison of success rate and intraocular pressure spikes between selective laser trabeculoplasty and micropulse laser trabeculoplasty in African American and Hispanic patients

“…The only factor that was identified as being associated with a higher treatment failure was a lower baseline IOP. This is consistent with previous studies that show that patients with a higher baseline IOP have better IOP lowering outcomes after SLT [21][22] . At least one previous study demonstrated that fewer laser spots was associated with high treatment failure [14] .…”

Long‐term follow‐up of laser trabeculoplasty in multi‐treated glaucoma patients

“…In the current study, there was no difference in LTP effect between eyes with POAG or PEXG, neither at 12 (Rasmuson et al, 2021) nor the 60-month follow-up visits. This was unexpected since patients with PEXG often have highly pigmented trabecular meshwork.…”

“…That report included a linear regression analysis defining the correlation between pre‐LTP IOP and the IOP reduction after laser treatment. It showed that LTP was beneficial in multi‐treated eyes if the IOP before laser was ≥15 mmHg and that the effect was maintained up to 1 year, but this was not true for eyes with IOP lower than 15 mmHg (Rasmuson et al, 2021).…”

Efficacy of Selective Laser Trabeculoplasty on Circadian Intraocular Pressure Following Trabeculectomy in Advanced Primary Open-angle Glaucoma

“…Interestingly, according to what was proven many times,3,24 a higher preoperative mdIOP was not a predictor for success in the cohort studied as was shown with regression and correlation analysis. We hypothesize, that prostaglandins, which are common mediators in the inflammatory response caused by SLT might enhance uveoscleral outflow in such a way that the pressure gradient is not the driving force.…”