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Tony Realini, Hilda Curtis; Repeat selective laser trabeculoplasty in Afro-Caribbean eyes with primary open-angle glaucoma. Invest. Ophthalmol. Vis. Sci. 201657(12):.
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© 2017 Association for Research in Vision and Ophthalmology.
To evaluate the intraocular pressure (IOP) lowering efficacy of repeat selective laser trabeculoplasty (SLT) in Afro-Caribbean people with primary open-angle glaucoma (POAG)
In this prospective cohort study, 61 St. Lucian subjects with POAG underwent initial bilateral 360-degree SLT after a complete medication washout in January 2011. Success was defined as a minimum 20% reduction from washout IOP with no further IOP-lowering interventions. IOP has been assessed by Perkins tonometry every 3 months since treatment. To date, 18 eyes of 10 subjects have undergone repeat 360-degree SLT upon failure of initial SLT; of these, 5 eyes of 3 patients have undergone a third 360-degree SLT upon failure of repeat SLT. Success of repeat SLT was identical to that of initial SLT: a minimum 20% reduction from baseline after washout before initial SLT with no further IOP-lowering medications.
Baseline IOP in the cohort of 18 eyes undergoing repeat SLT was 22.3 +/- 2.4 mmHg. Mean IOP at 3, 6, and 12 months after initial SLT was 15.1 +/- 2.3 mmHg, 17.8 +/- 3.5 mmHg, and 15.2 +/- 2.7 mmHg, respectively (p<=0.002 for all). Mean IOP at 3, 6, and 12 months after repeat SLT was 15.5 +/- 3.4 mmHg, 14.2 +/- 1.8 mmHg, and 14.8 +/- 1.5 mmHg, respectively (p<0.0001 for all). The median survival time of initial SLT was 9 months and of repeat SLT was 34.5 months. Of 18 eyes undergoing repeat SLT, 11 (61%) are considered successes at last follow-up (mean follow-up of 22 months; range 3 to 48 months). Of the 7 eyes failing repeat SLT, 5 underwent a third SLT (a mean of 35 months after second SLT) and all remain successes (mean IOP 12.8 +/- 2 mmHg; p<0.001) after a mean follow-up of 4.2 months; the remaining two eyes (of one subject) failed immediately after repeat SLT and medications were resumed. Including these 5 eyes, 16 of 18 (89%) remain successes without medications. No serious adverse events were observed in these 18 eyes undergoing 23 repeat treatments; no eyes experienced IOP spikes above 5 mmHg or anterior chamber inflammation requiring treatment. Most patients reported moderate photophobia with onset 1-2 days after treatment and resolving without treatment in 2-3 days.
SLT can be effectively repeated in Afro-Caribbean eyes with POAG to re-establish IOP control achieved with initial SLT without the need for medications. No safety issues were identified with repeat SLT in this population.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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