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  • Predictors of Success in Selective Laser Trabeculoplasty

    By Arthur Stone
    Selected By: Henry D. Jampel, MD, MHS

    Journal Highlights

    Ophthalmology Glaucoma, March/April 2020

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    In a large cohort of eyes undergoing selective laser trabeculoplasty (SLT), Kuley et al. sought to determine predic­tors of SLT success in lowering intra­ocular pressure (IOP) in patients with glaucoma. They found that greater pre-SLT IOP and angle pigment correlated positively with SLT success. Patient age, total SLT power, severity of glaucoma, and prior treatments were not associat­ed with SLT success or failure.

    For this retrospective case series, the authors evaluated 677 patients (997 eyes) who were treated at a single center by three glaucoma specialists between Jan. 1, 2012, and June 30, 2018. Baseline, demographic, procedural, and ophthalmic examination data were re­corded at the time of the first SLT. IOP and medication data were recorded at all follow-up visits. SLT success was defined as IOP decrease greater than or equal to 20% from baseline at the three-, six-, and 12-month follow-up visits. Eyes were considered to have failed and were censored when addi­tional SLT or glaucoma surgery was performed.

    The patients’ mean age was 70.2 (± 11.5) years. SLT success was achieved in 227 eyes (22.8%), while 770 (77.2%) failed to meet success criteria. Of the patients who did not achieve success, 523 failed due to insufficient reduction in IOP (<20% from baseline), and 46 failed due to requiring SLT or surgery. Pre-SLT IOP was 21.95 ± 5.2 mm Hg on 2.0 ± 1.2 medications in eyes with successful SLT, versus 19.0 ± 5.0 mm Hg (p < 0.0001) on 2.1 ± 1.3 medications (p = 0.52) in eyes with SLT failure.

    At one year, mean IOP in eyes with SLT success was 14.7 ± 3.2 mm Hg on 2.0 ± 1.2 medications, compared to 16.3 ± 4.7 mm Hg (p = 0.008) on a mean of 1.9 ± 1.3 medications (p = 0.37) in eyes that failed SLT. Eyes with SLT success more often had greater angle pigment grading. There was no correlation between SLT outcomes and patients’ age, glaucoma severity, total SLT power, type of glaucoma, visual field mean defect, or retinal nerve fiber layer thick­ness.

    The original article can be found here.