Predictive Factors for Outcomes of Selective Laser Trabeculoplasty

Abstract

We sought to determine predictive factors for selective laser trabeculoplasty (SLT) outcome. 252 eyes from 198 adult patients with open-angle glaucoma who underwent SLT between July 2016 and February 2018 with a minimum 6 month follow up were reviewed. We defined success as ≥20% IOP reduction or ≥1 medication reduction without an IOP lowering procedure. We also evaluated the relationship of these factors to postoperative iop elevation >5 mmHg (IOP spikes). Our primary outcome measure was association between age, type and severity of glaucoma, pigmentation of the trabecular meshwork (PTM), total energy delivered, and baseline intraocular pressure (IOP) with success. At 2 and 6 months, 33.6% (76/226) and 38.5% (97/252) of eyes met success criteria respectively. Baseline IOP > 18 mmHg was significantly associated with success both at 2 and 6 months, reducing IOP by 5.4 ± 5.3 mmHg (23.7% reduction), whereas those with lower baseline remained at −0.7 ± 4.6 mmHg (4.9% increase) at 6 months (P < 0.001). No other baseline characteristics significantly predicted success or IOP spikes. Patients with higher baseline IOPs had greater success rates and mean IOP reduction at both 2 and 6 months following SLT. Age, type and severity of glaucoma, PTM, or total energy delivery had no association with procedural success or IOP spikes. Patients with higher baseline IOP may experience greater lowering of IOP after SLT. However, SLT may be equally successful for patients with a variety of other characteristics.

Selective Laser Trabeculoplasty in the Treatment of Ocular Hypertension and Open-Angle Glaucoma: Clinical Review

“…With 72 patients evaluated at their one-year follow-up, Hodge et al demonstrated that SLT success was strongly predicted by baseline IOP (odds ratio = 1.16; p = 0.0001) and not by age, sex, glaucoma type or grade of TM pigmentation [ 62 ]. Similar results were shown in a recent retrospective review by Hirabayashi et al [ 63 ]. In this study, at 6 months, patients with a baseline IOP > 18 mmHg showed an IOP reduction of 5.4 ± 5.3 mmHg (23.7% reduction), whereas patients with a baseline IOP < 18 mmHg showed a reduction of −0.7 ± 4.6 mmHg (4.9% increase; p < 0.001).…”

“…These results are consistent with three other trials. The results of a post hoc analysis of the LIGHT study by Garg et al (mentioned above in the subsection “SLT as first-line therapy”) showed that early absolute IOP reduction was positively correlated with baseline IOP and negatively correlated with female gender [ 13 , 14 , 31 , 62 , 63 , 64 , 65 , 66 ].…”

Real-world data from selective laser trabeculoplasty in Brazil

“…The investigation of predictors of success for SLT is important to guide the clinician into obtaining better outcomes and to provide patients with information regarding risks of failure and procedure outcomes. Despite previous studies have described baseline IOP as predictor of success, in our univariable and multivariable analyses, baseline IOP did not achieve statistical significance 14 , 29 . We found that patients with less advanced functional damage had better chances of obtaining success after SLT in the univariable analysis.…”

Real-World Data from Selective Laser Trabeculoplasty in Brazil

“…Despite previous studies have described baseline IOP as predictor of success, in our univariable and multivariable analyses, baseline IOP did not achieve statistical signi cance. 14,29 We found that patients with less advanced functional damage had better chances of obtaining success after SLT in the univariable analysis. This nding reinforces the concept that SLT is a good option for initial treatment, especially for those with mild glaucoma comparing to patients with moderate and advanced glaucoma that might require a lower target pressure.…”