Selective laser trabeculoplasty: past, present, and future

Garg, Anurag; Gazzard, Gus

doi:10.1038/eye.2017.273

Cited by 95 publications

(96 citation statements)

References 116 publications

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“…26 We also found in our analysis that female gender was associated with lesser initial IOP lowering, not a commonly reported predictor of IOP lowering. 22 Our results show that at 36 months follow-up, 74.6% of eyes (400 eyes) treated with primary SLT achieved drop-free disease-control, with 58.2% of eyes (312 eyes) doing so after a single initial SLT. All these eyes achieved IOP reduction >20% from baseline IOP.…”

Section: Discussionmentioning

confidence: 63%

“…In the SLT literature, the most commonly defined measure of success is a minimum IOP reduction of !20% from baseline IOP after SLT at a specified time point, without the need for further intervention. 22 In LiGHT, the predefined target IOPs required a minimum IOP reduction of >20% from baseline IOP for all disease severities (Table 2); thus, eyes achieving drop-free disease-control at 36 months after a single, initial SLT would serve as a useful (although more stringent) success comparator with preexisting SLT studies. A logistic regression analysis of factors to predict eyes achieving drop-free disease-control at 36 months after initial, single SLT was performed.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 63%

Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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“…This mirrors clinical practice in which treatment escalations (medication, laser, or surgery) are usually not delayed to allow IOP to return to pretreatment levels. Higher starting baseline IOP has been found to be a predictor of greater absolute IOP lowering, 30 and thus mean absolute IOP reduction was expected to be less for repeat SLT compared with initial SLT (e.g., at 2 months, mean difference 1.0 mmHg, 95% CI, 0.2e1.8; P < 0.001). The greater adjusted absolute IOP reduction after repeat SLT, controlling for the difference in pretreatment IOP, suggests that further laser may be additive to the initial treatment.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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on behalf of the Laser in Glaucoma and Ocular Hypertension Trial Study Group* Purpose: To determine the efficacy of repeat selective laser trabeculoplasty (SLT) in medication-naive openangle glaucoma (OAG) and ocular hypertensive (OHT) patients requiring repeat treatment for early to mediumterm failure during the Laser in Glaucoma and Ocular Hypertension (LiGHT) trial. Design: Post hoc analysis of SLT treatment arm of a multicenter prospective randomized controlled trial. Participants: Treatment-naive OAG or OHT requiring repeat 360-degree SLT within 18 months. Retreatment was triggered by predefined IOP and disease-progression criteria (using objective individualized target IOPs). Methods: After SLT at baseline, patients were followed for a minimum of 18 months after second (repeat) SLT. A mixed-model analysis was performed with the eye as the unit of analysis, with crossed random effects to adjust for correlation between fellow eyes and repeated measures within eyes. KaplaneMeier curves plot the duration of effect. Main Outcome Measures: Initial (early) IOP lowering at 2 months and duration of effect after initial and repeat SLT. Results: A total of 115 eyes of 90 patients received repeat SLT during the first 18 months of the trial. Pretreatment IOP before initial SLT was significantly higher than before retreatment IOP of repeat SLT (mean difference, 3.4 mmHg; 95% confidence interval [CI], 2.6e4.3 mmHg; P < 0.001). Absolute IOP reduction at 2 months was greater after initial SLT compared with repeat SLT (mean difference, 1.0 mmHg; 95% CI, 0.2e1.8 mmHg; P ¼ 0.02). Adjusted absolute IOP reduction at 2 months (adjusting for IOP before initial or repeat laser) was greater after repeat SLT (adjusted mean difference, À1.1 mmHg, 95% CI, À1.7 to À0.5 mmHg; P ¼ 0.001). A total of 34 eyes were early failures (retreatment 2 months after initial SLT) versus 81 later failures (retreatment >2 months after initial SLT). No significant difference in early absolute IOP reduction at 2 months after repeat SLT was noted between early and later failures (mean difference, 0.3 mmHg; 95% CI, À1.1 to 1.8 mmHg; P ¼ 0.655). Repeat SLT maintained drop-free IOP control in 67% of 115 eyes at 18 months, with no clinically relevant adverse events. Conclusions: These exploratory analyses demonstrate that repeat SLT can maintain IOP at or below target IOP in medication-naive OAG and OHT eyes requiring retreatment with at least an equivalent duration of effect to initial laser.

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“…However, SLT, the most common and perhaps the most advanced among laser therapy techniques, has emerged as an option for glaucoma patients as of the early 2000s. 67 The efficacy and safety of SLT have been evaluated in several clinical trials and observational studies. [68][69][70][71][72][73][74][75][76][77][78] With respect to SLT, the LiGHT study is an interesting observer-masked, randomized controlled trial that enrolled treatment-naïve patients with open angle glaucoma or ocular hypertension and no ocular comorbidities.…”

Section: Selective Laser Trabeculoplasty (Slt)mentioning

confidence: 99%

<p>Minimally Invasive Surgery in Mild-to-Moderate Glaucoma Patients in Italy: Is It Time to Change?</p>

Costagliola¹,

Sbordone²,

Gandolfi³

et al. 2020

OPTH

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Medical therapy is the first treatment choice for most patients with glaucoma; however, in a relevant proportion of patients, intraocular pressure (IOP) reduction is achieved with multi-therapy and/or high therapeutic doses. Conventional surgery is the standard alternative to medical therapy when this is not effective or not tolerated. Recently, selective laser trabeculoplasty (SLT) has been advocated as first-line therapy, and "minimally invasive glaucoma surgery" (MIGS) has been developed as safer and less traumatic surgical intervention for patients with glaucoma. Schlemm's canal surgery has emerged as one of the approaches with the most favorable risk-benefit profile for glaucoma patients in need of cataract surgery. However, despite the promising results, use of MIGS in Italy has been extremely low. We aimed to investigate the reasons of the lower-than-expected use of Schlemm's canal-based MIGS devices in Italy, share our perspective on their potential place in therapy, and give practical suggestions to improve the management of glaucoma patients.

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Selective laser trabeculoplasty: past, present, and future

Cited by 95 publications

References 116 publications

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

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

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

<p>Minimally Invasive Surgery in Mild-to-Moderate Glaucoma Patients in Italy: Is It Time to Change?</p>

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