Long-term safety and efficacy of selective laser trabeculoplasty as primary therapy for the treatment of pseudoexfoliation glaucoma compared with primary open-angle glaucoma

Abstract

PurposeTo investigate the safety and efficacy of selective laser trabeculoplasty (SLT) to reduce intraocular pressure (IOP) in patients with pseudoexfoliation glaucoma (PXFG) compared with primary open-angle glaucoma (POAG).DesignNon-randomized, prospective, clinical trial.MethodsNineteen eyes of 13 patients with POAG and 18 eyes of 13 patients with PXFG were treated with SLT. Patients were followed without antiglaucoma medications until additional medical, laser, or surgical intervention was initiated, at which time they were considered failures, had withdrawn from the study, or underwent a second SLT.ResultsThe POAG and PXFG eyes showed similar reductions of IOP over the 49 months of follow-up. At 30 months of follow-up the POAG group showed a mean IOP of 17.6 ± 2.8 mmHg and a mean IOP reduction of 5.7 ± 2.1 mmHg; the PXFG group showed a mean IOP of 18.3 ± 4.7 and a mean IOP reduction of 5.3 ± 3.0 mmHg. Four eyes in the PXFG group and three eyes in the POAG group failed by 30 months. The cumulative probability of success was 74% for the PXFG group and 77% for the POAG group. Four PXFG eyes underwent a second SLT after 30 months of follow-up with a final IOP of 17.6 ± 2.8 mmHg. There were no serious adverse events.ConclusionSLT is a safe and effective method to lower IOP in patients with PXFG as initial glaucoma therapy. Both groups showed similar IOP reductions and failure rates.

Corneal changes after a single session of selective laser trabeculoplasty for open-angle glaucoma

“…2 SLT has been established to be a safe procedure with few known side effects including post-procedure intraocular pressure (IOP) elevation, blurred vision, ocular irritation and iritis, all of which are generally transient, lasting no more than a few days. [3][4][5][6][7][8] Permanent corneal changes after SLT are extremely rare with only two reported cases 9 in the literature of corneal edema, haze, and thinning occurring within 24-48 h post laser. These cases resulted in irreversible corneal scarring, thinning, and a myopic shift in refractive error.…”

Selective laser trabeculoplasty as an initial treatment option for open-angle glaucoma

“…When evaluating patients with OAG or ocular hypertension (OHT) treated with SLT, Melamed et al (33) observed a ≥19.6% IOP reduction in 89% of the patients, while Mahdy (29) found an IOP-reduction ≥25% in 77.1% of the cases. Overall, in an attempt to summarize IOP data from the available studies, we found that average absolute IOP-reduction following SLT as first treatment ranges from 3 to 8 mmHg (percentage IOP reduction: 20% to 38%) (17,18,29,31,33,34) . Other studies compared SLT versus PGA as a primary therapy, with similar efficacy between the two treatment modalities (16)(17)(18) .…”

“…As PGAs are the first line clinical treatment to OAG, most studies compared SLT with PGA results in terms of IOP reduction. Looking carefully at safety and efficacy outcomes of these studies, we believe there is growing evidence that SLT can be used as a primary treatment for IOP-control in OAG cases (17,(28)(29)(30)(31)(32)(33) . Table 2 provides a summary of the main results of these studies.…”

“…In addition, another study also evaluated SLT results after topical medication washout, and SLT 360° was effective [mean IOP reduction of 2.9 mmHg (40%) at 3 months and 2.1 mmHg (29.2%) at 6 months after the laser) (35) . Besides that, another study that included eyes with pseudoexfoliative glaucoma (XFG) and primary openan gle glaucoma (POAG) revealed that SLT was effective as a primary treatment in both groups (31) .…”

“…Some success predictors are well established. For instance, better results are usually observed in patients with POAG (33,37,(51)(52)(53)(54)(55)(56) , pseudoexfoliative glaucoma (31,40,57,58) , and higher baseline IOP (40,41,46,47) . A few isolated studies observed better results in eyes with thinner corneas (59) , with earlier disease stage (60) , and with higher refractive errors (52) .…”