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  • Selective Laser Trabeculoplasty Outcomes in the United Kingdom

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD

    Journal Highlights

    Ophthalmology, June 2020

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    Selective laser trabeculoplasty (SLT) successfully reduces intraocular pres­sure (IOP) in patients with open-angle glaucoma and ocular hypertension, especially those who are treatment-naive. To determine whether these results translate to clinical practice, Khawaja et al. analyzed electronic health records gathered from five U.K. ophthalmology teaching centers. They found that although most eyes with elevated IOP responded to SLT in the short term, treatment failed in three-quarters of eyes within two years, and many patients eventually needed more glaucoma medication or another procedure.

    For this study, the researchers de-identified medical records and re­viewed them for demographics, proce­dures, outcomes, and factors linked to treatment success. The main outcomes were changes from baseline in IOP and number of glaucoma medications. A Kaplan-Meier probability analysis was used to determine treatment success. Failure was defined as any of the following: need for another procedure (including repeat SLT), two consecutive visits with IOP >21 mm Hg or IOP reduction <20%, or two consecutive visits with a higher number of glauco­ma medications than at baseline.

    Altogether, 831 patients met the eligibility criteria. The mean follow-up time was 19.4 months (range, 3-67 months). In the 12-to 18-month window (439 eyes), the mean change in IOP was ‒4.2 mm Hg; in the subse­quent 12 months (243 eyes), it was ‒3.4 mm Hg (both p < .0001). The mean increases in glaucoma medications per eye were 0.13 (p = .007) and 0.20 (p = .005), respectively. The probability of treatment success was 70% at six months but declined to 45%, 34%, 27%, and 18% by months 12, 18, 24, and 36, respectively. IOP >21 mm Hg at baseline was associated with a 33% reduction in the risk of failure (hazard ratio, 0.67; p < .001). Age, sex, baseline visual field mean deviation, and use of IOP-lowering drugs had no association with successful outcomes.

    Although the success rate for SLT was 70% at six months, it dropped to 27% by 24 months. The decline in visual field mean deviation in the later timeframes supports common wisdom that the effects of treatment typically slow and may lead to disease progres­sion. The authors ascribed the link between baseline IOP and treatment success to a likely floor effect with SLT, indicating that the procedure may be better suited for ocular hypertension orhigh-tension primary open-angle glaucoma than for normal-tension glaucoma.

    The original article can be found here.