Abstract
Purpose: :
A theoretical mechanism of selective laser trabeculoplasty (SLT) is cytokine release from trabecular meshwork cells causing a remodeling by macrophages. This remodeling is believed to decrease intraocular pressure through increased aqueous outflow. It would follow that the use of topical corticosteroids would have a theoretical potential to blunt this response. Previous studies looking at this mechanism have included a small numbers (25 participants) and short follow up (<3 months) without showing a significant difference. We wished to determine the short and long term effect of co-administration of loteprednol with selective laser trabeculoplasty through a retrospective chart review.
Methods: :
A total of 318 eyes from 313 patients (ages 30-85) were found to have had an SLT from January 1, 2008 to August 31, 2011 in the medical records of Sabates Eye Centers, (Kansas City, Missouri). We included glaucoma diagnoses of primary open angle, pseudoexfoliation, low tension, and pigmentary. We excluded other glaucoma diagnoses, cataract extraction within 6 months of SLT, other previous intraocular surgery, previous SLT, change in glaucoma topical medication numbers, and corticosteroid administration within 3 months of SLT. We used a two-tailed t test to compare the absolute change in IOP from baseline at 1 month (2-6 weeks), 4 months (2-6 months), and 1 year (9-15 months) for patients receiving loteprednol co-administration and those who did not. Group 1 included 4 glaucoma diagnoses. Group 2 included only primary open angle.
Results: :
We found statistically significant superiority for non-loteprednol co-administrations in Group 1 and 2 at 4 month intervals (p=0.03 and p=0.029), but not the 12 month (p=0.32 and p=0.49). Group 1 had an absolute difference of -1.14 mm Hg and -0.60 mm Hg at 4 and 12 months, respectively. Group 2 had -1.24 mm Hg and -0.45 mm Hg at 4 and 12 months, respectively. There was no significant difference in the number of glaucoma medications (p values >0.28).
Conclusions: :
Given the cost of loteprednol and the increased effectiveness of SLT at 4 months and questionably at 12 months without co-administration of loteprednol, we recommend that loteprednol only be given when clinically indicated. We recommend further study to determine the effects of other corticosteroids on the effectiveness of SLT.
Keywords: trabecular meshwork • corticosteroids • anterior segment