April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
LOW POWER SELECTIVE LASER TRABECUOPLASTY (SLT) REPEATED YEARLY AS PRIMARY TREATMENT IN OCULAR HYPERTENSION: LONG TERM COMPARISON WITH CONVENTIONAL SLT AND ALT
Author Affiliations & Notes
  • Stefano A Gandolfi
    Ophthalmology, University of Parma, Parma, Italy
  • Nicola Ungaro
    Ophthalmology, University of Parma, Parma, Italy
  • Footnotes
    Commercial Relationships Stefano Gandolfi, None; Nicola Ungaro, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 818. doi:
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      Stefano A Gandolfi, Nicola Ungaro; LOW POWER SELECTIVE LASER TRABECUOPLASTY (SLT) REPEATED YEARLY AS PRIMARY TREATMENT IN OCULAR HYPERTENSION: LONG TERM COMPARISON WITH CONVENTIONAL SLT AND ALT. Invest. Ophthalmol. Vis. Sci. 2014;55(13):818.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

to compare the efficacy of 360° low-power selective laser trabeculoplasty (SLT) timed yearly with (a) 360° SLT repeated as needed, and (b) 360° argon laser trabeculoplasty (ALT) performed once, as primary treatment in ocular hypertension

 
Methods
 

Design: retrospective chart review of three consecutive case series; Eligibility criteria: (a) ocular hypertension in at least one eye, (IOP repeatedy > 22 mmHg, normal standard automatic perimetry) , (b) open angle, (c) no PEX or PDS (d) consenting to undergo a laser trabeculoplasty as a primary treatment; number of subjects : n = 112 (in case of both eyes treated, OD was analyzed) ; treatment arms: (A) 360° low power SLT (0.4 mJ, 50-60 spots) timed yearly, (B) 360° SLT , 70-80 spots, power increased stepwise, until obtaining an “air-bubble”, to decrease one step eventually, to be repeated PRN in case of long-term failure, (C) 360° ALT, (50u spot, 0.5 - 0.8 W, 70-90 spots) performed once; follow up: mean follow up time = 6.5 years (range 3 - 10 yrs); main outcome: number of subjects with no anti-glaucoma medications ; secondary outcome(s): (a) mean time to initiation of medical therapy, (b) number and type of medications ; data analysis: Kaplan - Meier survival curve (main outcome).

 
Results
 

The demographics of the study cohorts is as follows: (A) n = 46, mean (st.dev) pre treatment IOP = 25.4 (2.2), visual acuity (LogMAR) = 0.14 (0.22), CCT=558 (47) u, mean follow up time (yrs) = 7.4 (range 4 - 10); (B) n = 37, mean (st.dev) pre treatment IOP = 24.6 (3.1), v.a. (LogMAR) = 0.11 (0.14), CCT=547 (32) u, mean follow up time (yrs) = 5.6 (range 3 - 10); (C) n = 39, mean (st.dev) pre treatment IOP = 26.1 (2.7),v.a. (LogMAR) = 0.18 (0.26), CCT=561 (42) u, mean follow up time (yrs) = 6.7 (range 4 - 10). The percentage of subjects with no antiglaucoma medications was as follows: 84% Group A , 47% Group B, 38% Group C (p < 0.01 A vs either B or C, p =0.47 B vs C). The mean time to initiation of medical therapy was 6.2 (2.4) yrs Group A, 3.3 (4.7) yrs Group B and 3.5 (5.2) yrs Group C (unpaired samples Student t test, p < 0.05 A vs either B or C, p > 0.5 B vs C).

 
Conclusions
 

Low power 360° SLT repeated every year is a more effective primary treatment in ocular hypertension, and maintains patients free of medications for a longer period of time, than either ALT or mid-power SLT repeated as needed.

 
Keywords: 578 laser • 568 intraocular pressure • 633 outflow: trabecular meshwork  
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