Repeat selective laser trabeculoplasty can be effective in eyes with initial modest response

Abstract

Purpose:To evaluate the effectiveness of repeat selective laser trabeculoplasty (SLT) in eyes exhibiting only a modest response upon initial treatment.Materials and Methods:Retrospective chart review was conducted of 51 eyes that received initial 360 degree SLT (SLT1) and subsequent SLT (SLT2) from 2003-2011 at a large academic ophthalmology practice. Successful response (S) was a post-treatment 12 month mean IOP reduction ≥20% from baseline, while modest response (M) was <20% reduction over the same time. Chi-squared and log rank analyses were used to determine if success after SLT2 depended on having successful (S1) or modest (M1) response after SLT1.Results:IOP was significantly reduced from baseline in both SLT1 and SLT2. The proportion of eyes with S2 was not significantly different between those with initial M1 or S1 (36.67% vs. 52.38%, respectively; P = 0.26). Log rank analysis revealed no differences between M1 and S1 in determining SLT2 success (P = 0.41). This outcome was similar when the analyses were performed for the right and left eye independently.Conclusion:The proportion of eyes that successfully responded to repeat SLT did not differ based upon whether the response to initial SLT was successful or modest. This raises the possibility that repeat SLT should not be excluded as an option for those eyes that have only a modest initial response.

Primary Open-Angle Glaucoma Preferred Practice Pattern® Guidelines

“…Similar IOP reduction and success rates have been observed with repeat SLT compared with initial SLT in retrospective studies. [352][353][354] The safety profile of SLT appears to be good, with mild anterior chamber inflammation after treatment and less ocular discomfort compared with ALT. 346 Intraocular pressure spikes have been noted after SLT in 4.5% to 27% of eyes in various studies, 343,347,351,355 which are similar to rates observed with ALT.…”

Repeatability of selective laser trabeculoplasty

“…In 2013, Avery et al 7 found that repeat 360° SLT has similar efficacy to primary 360° SLT with respect to reduction in IOP and success rates (IOP reduction of ≥20% from an individually determined target IOP), producing a longer duration of treatment success. In 2014, Khouri et al 10 reported that initial and repeat SLT significantly reduced IOP and the success of repeat SLT was independent of the response to initial SLT and produced an effective IOP reduction for up to 24 months 9…”

Efficacy of Repeat Selective Laser Trabeculoplasty in Medication-Naive Open-Angle Glaucoma and Ocular Hypertension during the LiGHT Trial

“…Repeatability of SLT has been studied and considered feasible in suitable patients requiring further IOP reduction. [7][8][9][10][11][12][13][14] However, many of these studies are retrospective and limited by small sample sizes and lack predefined retreatment criteria. In addition, in all but 1 of these studies, 13 SLT was used as an adjunctive treatment in patients already receiving topical IOP-lowering treatment.…”