Primary Selective Laser Trabeculoplasty for Open-Angle Glaucoma and Ocular Hypertension

Abstract

on behalf of the Laser in Glaucoma and Ocular Hypertension Trial Study Group* Purpose: To report clinical efficacy, predictors of success, and safety of primary selective laser trabeculoplasty (SLT) used in treatment-naive patients with open-angle glaucoma (OAG) or ocular hypertension (OHT). Design: Post hoc analysis of a multicenter, prospective, randomized, controlled trial. Participants: Treatment-naive patients with OAG or OHT. Methods: Patients randomized to SLT or topical medication and treated to predefined target intraocular pressures (IOPs) requiring !20% IOP reduction from baseline for all disease severity levels. Outcome Measures: Initial (early) absolute IOP-lowering at 2 months. Achievement of drop-free diseasecontrol: meeting target IOP without disease progression or need for additional topical medication over 36 months after SLT. Predictors of early absolute IOP-lowering and drop-free disease-control after single initial SLT. Frequency of laser-related complications. Results: A total of 611 eyes (195 OHT and 416 OAG) of 355 patients received SLT, and 622 eyes (185 OHT and 437 OAG) of 362 patients received topical medication at baseline. Early absolute IOP-lowering after SLT was no different between OHT and OAG eyes (adjusted mean difference ¼ À0.05 mmHg; 95% confidence interval [CI], À0.6 to 0.5 mmHg; P ¼ 0.85). No difference was noted in early absolute IOP-lowering between topical medication and primary SLT (adjusted mean difference ¼ À0.1 mmHg; 95% CI, À0.6 to 0.4 mmHg; P ¼ 0.67). Early absolute IOP-lowering with primary SLT was positively associated with baseline IOP (coefficient 0.58; 95% CI, 0.53e0.63; P < 0.001) and negatively with female gender (coefficient À0.63; 95% CI, À1.23 to À0.02; P ¼ 0.04). At 36 months, 536 eyes (87.7% of 611 eyes) of 314 patients (88.5% of 355 patients) were available for analysis. Some 74.6% of eyes (400 eyes) treated with primary SLT achieved drop-free disease-control at 36 months; 58.2% (312 eyes) after single SLT. Total SLT power and 2-month IOP were predictors of drop-free disease-control at 36 months after single SLT. Six eyes of 6 patients experienced immediate post-laser IOP spike (>5 mmHg from pretreatment IOP) with 1 eye requiring treatment. Conclusions: Primary SLT achieved comparable early absolute IOP-lowering in OHT versus OAG eyes. Drop-free disease-control was achieved in approximately 75% eyes at 36 months after 1 or 2 SLTs, the majority of these after single SLT. These analyses are exploratory but support primary SLT to be effective and safe in treatment-naive OAG and OHT eyes.

Laser trabeculoplasty in newly diagnosed multi‐treated glaucoma patients

“…Heijl et al concluded that the effect can best be predicted by the preoperative IOP level and showed that higher IOP before ALT was associated with greater IOP reduction following topical treatment (Heijl et al 2011). This finding has also been described by others (Chun et al 2016;Pillunat et al 2016;Garg et al 2019). However, most of those studies included eyes with elevated IOP levels prior to LTP and which were in need of additional IOP reduction.…”

“…Laser trabeculoplasty (LTP) is a wellknown method to reduce the intraocular pressure (IOP) in open-angle glaucoma (OAG). Sometimes, it is used as a first-line treatment (Tuulonen et al 1987;The Glaucoma Laser Trial Research Group 1990;Melamed et al 2003;McIlraith et al 2006;Shazly et al 2010;Garg et al 2019), but more commonly it serves as a supplement to topical IOP-lowering medication (Samples et al 2011;Pillunat et al 2016). Traditionally, argon laser trabeculoplasty (ALT), a method originally comprising argon laser but more recently a diode laser, has been more frequently used (Wise & Witter 1979;Chung et al 1998;Samples et al 2011).…”

Selective laser trabeculoplasty (SLT) performed by optometrists for patients with glaucoma and ocular hypertension: a scoping review

“…For example, recent analysis from the LiGHT trial demonstrated that total SLT power and 2-month IOP were predictors of drop-free disease control at 36 months after single SLT. 30 Moreover, patients who are more medically complex tend to be treated by an ophthalmologist as opposed to an optometrist which should be controlled for when making comparisons between group outcomes. 31…”

Open-Angle Glaucoma: Burden of Illness, Current Therapies, and the Management of Nocturnal IOP Variation

“…Selective laser trabeculoplasty (SLT) is the least invasive surgery and the most frequently performed laser surgery procedure for treating POAG, employing low-energy laser beams to microscopically modify the trabecular meshwork TM and improve aqueous drainage [20]. In addition to avoiding adherence and cost issues associated with daily pharmacotherapy, research suggests that patients who initiate treatment with laser procedures show improved IOP lowering [36][37][38]. Data indicate, however, that laser procedures targeting the TM have limited duration and repeatability, particularly with ALT (argon laser trabeculoplasty), as SLT can be repeated.…”