• Glaucoma

    Review of: Predictors of Success in Selective Laser Trabeculoplasty

    Kuley B, Zheng C, Zhang Q, et al. Ophthalmology Glaucoma, March–April, 2020

    This large retrospective study evaluated the outcomes of selective laser trabeculoplasty.

    Study design

    This analysis retrospectively evaluated 997 eyes that underwent selective laser trabeculoplasty (SLT) between January 2012 and June 2018. Success was defined as an IOP decrease of 20% or more at follow-ups in months 3, 6 and 12. Rate of success along with risk factors for success and failure were evaluated.

    Outcomes

    A total of 997 eyes of 677 patients were included in the study. The rate of success was 22.8%. Of those not achieving success, more than 90% failed due to insufficient IOP reduction at all 3 time points. There was no difference in the number of IOP lowering medications in eyes with successful SLT versus failed SLT at baseline and at 12 months.

    Greater angle pigmentation and mean baseline IOP were significant predictors of success. Age, gender, SLT settings or type of glaucoma were not predictive of success. Of note, only 20 patients had a baseline IOP greater than 24 mm Hg, of which only 6 patients (30%) achieved success.

    Limitations

    As this was a retrospective study, only a single IOP measurement was available at each time point, potentially leading to regression toward the mean. It was also limited by its retrospective nature as it lacked standardization for performing SLT and follow-up visits. Baseline IOP was lower in this study compared with other similar studies, such as the laser in glaucoma and ocular hypertension (LiGHT) trial study. The authors argue that the higher baseline IOP seen in other studies would have made it easier to achieve a 20% decrease and therefore explain the lower success rate for SLT in this study in comparison.

    Clinical significance

    This study might make clinicians more likely to utilize SLT when preprocedural IOP is elevated, but less likely to use SLT if the baseline IOP is less than 20 mm Hg. One might also prefer SLT with greater trabecular meshwork pigmentation.