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Christina Kytasty, Amanda Allan, Jessica M Ackert; The utility of selective laser trabeculectomy (SLT) as adjunct therapy in moderate to advanced glaucoma patients.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6120.
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The utility of selective laser trabeculectomy (SLT) as adjunct treatment in moderate to advanced glaucoma patients has not been thoroughly investigated. We performed a retrospective chart review to evaluate the efficacy of SLT in this patient population.
Thirty-nine patients (47 eyes) with moderate to severe open-angle glaucoma and uncontrolled IOP were treated with SLT. Moderate to severe glaucoma was defined as a reproducible mean deviation of -10.00 or worse on a Humphrey Visual Field, in accordance with the peer-reviewed literature. Target intraocular pressure (IOP) was determined by a 30% reduction of the maximum pressure. Mean age was 66.8 years. 56.4% of patients were female and 43.6% male. 79.5% of patients were African-American, 10.3% Hispanic, and 10.2% Caucasian. Patients were treated with SLT (180-360 degrees) initially and monitored for reduction in IOP. If target IOP range was not attained, additional SLT, medication, or surgical intervention was performed.
Thirty-nine patients, 47 eyes, were treated with SLT. Follow-up ranged from 1 to 80 months. 13 eyes, 28%, had successful reduction of IOP after 1 SLT and have not required escalation of therapy. The duration of success varied: 15.4% less than 180 days (mean 79±46.7 days), 53.8% have had success for 181-360 days (mean 296.6±49.0 days), 15.4% have had success for 361-730 days (mean 409±45.3 days), and 15.4% have had success for 731-2441 days (mean 948±73.5 days). 25 eyes (53%) treated with SLT subsequently required additional therapy, either in the form of IOP-lowering medication (60%), or filtering surgery (40%). 44% had a time to failure of less than 180 days (mean 83.9±55.3 days), 24% had a time to failure of 181-360 days (mean 244.8±66.1 days), 20% had a time to failure 361-730 days (mean 541.8±119.7 days), and 12% had a time to failure 731-2441 days (mean 1584.7±751.3 days). 9 eyes (19%) required multiple therapies, either repeat SLT, additional drops, or filtering surgery. 44% failed after less than 365 days (mean 166±92.5 days), and 56% 365-1840 days (mean 1182.2±455.3 days).
SLT appears to be an effective adjunct with medication in providing pressure reduction in a predominantly African-American population with moderate to advanced glaucoma with nearly 81% of patients enjoying improved IOP control for approximately 391.8 days (34-2441 days).
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