A Prospective Randomized Clinical Trial of Selective Laser Trabeculoplasty versus Argon Laser Trabeculoplasty in Open Angle Glaucoma and Ocular Hypertension Secondary to Pseudoexfoliation

Abstract

Purpose: : To evaluate the efficacy of selective laser trabeculoplasty (SLT) versus argon laser trabeculoplasty (ALT) in lowering intraocular pressure (IOP) in patients with open angle glaucoma or ocular hypertension secondary to pseudoexfoliation (PXF).

Methods: : A prospective randomized clinical trial was conducted in eyes with PXF and uncontrolled IOP treated with SLT or ALT. The primary outcome was the change in IOP at 6 and 12 months vs baseline and a secondary outcome included change in number of glaucoma medications post-laser. Baseline variables included age, gender, angle grade, angle pigmentation and number of glaucoma medications. Patients with prior laser trabeculoplasty, ocular surgery within 6 months, previous glaucoma surgery, an advanced visual field defect, current steroid use, and monocular patients were excluded.

Results: : Seventy-six eyes of 60 patients with PXF underwent either 180-degree SLT or 180 degree ALT. The baseline IOPs in the SLT and ALT groups were 23.1mmHg and 25.2 mmHg respectively (p= 0.03). The IOP reductions 6 and 12 months post SLT were -6.8 mmHg and -6.2 mmHg, respectively. The IOP reductions post ALT were -7.7 mmHg and - 8.6 mmHg at 6 and 12 months. Neither the 6 nor the 12 month pressure reduction difference was statistically significant between groups. The SLT group had reduced medications by an average of 0.30 drop at 1 year and the ALT group had decreased use of glaucoma drops by an average of 0.13 drop over the same time period (p=0.65). There were no post laser IOP spikes in either group.

Conclusions: : ALT and SLT are equivalent in lowering IOP at 6 and 12 months post treatment in patients with PXF.

Clinical Trial: : http://www.clinicaltrials.gov NCT01126203

Keywords: clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • intraocular pressure • trabecular meshwork