July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
LOW POWER SELECTIVE LASER TRABECULOPLASTY (SLT) REPEATED YEARLY AS PRIMARY TREATMENT IN OPEN ANGLE GLAUCOMA(S): 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
  • luigi Varano
    Ophthalmology, University of Parma, Parma, Italy
  • Sergio Saccà
    Ophthalmology, University of Genova, Genova, Italy
  • Footnotes
    Commercial Relationships   Stefano Gandolfi, None; Nicola Ungaro, None; luigi Varano, None; Sergio Saccà, None
  • Footnotes
    Support  none
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 3459. doi:
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      Stefano A Gandolfi, Nicola Ungaro, luigi Varano, Sergio Saccà; LOW POWER SELECTIVE LASER TRABECULOPLASTY (SLT) REPEATED YEARLY AS PRIMARY TREATMENT IN OPEN ANGLE GLAUCOMA(S): LONG TERM COMPARISON WITH CONVENTIONAL SLT AND ALT. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3459.

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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 open angle glaucoma(s)

Methods : The data base of the Glaucoma Clinic of our dpt. was searched for patients, affected by open angle glaucoma in at least one eye (IOP repeatedly > 22 mmHg and abnormal visual field (24/2 or 30/2 SITA Standard) scheduled for a laser trabeculoplasty, as a primary treatment, from the year 2001 onwards. Patients started on topical anti-glaucoma medications, in the fellow eye, during follow up , and eyes undergoing a bulbar surgery during follow up. were excluded. The records of 216 consecutive patients, with a minimum follow up of three years, were considered. In case both eyes were treated, OD only was arbitrarily chosen for the analysis.The following data were collected : IOP,.Best corrected visual acuity, timing of initiation of medical treatment, optic disc data, Visual field. Treatment settings: 360° low power SLT (0.4 mJ, 50-60 spots) , to be repeated every year, independently of the measured IOP (Group A), 360° SLT , (70-80 spots, power increased from 0.5 mJ stepwise until an “air-bubble” was obtained; then, the power was lowered by one energy step) to be repeated PRN in case the clinician considered IOP out of control (Group B), 360° ALT, (50 m spot, 0.5 – 0.8 W, 70-90 spots) performed once, with no re-treatments allowed (Group C). Main efficacy outcome: percentage of subjects with no anti-glaucoma medications; secondary efficacy outcome(s): (a) mean time to initiation of medical therapy, (b) number and type of medications.

Results : Mean IOP (mmHg) and MD (dB) on presentations were as follows: 25.4+3.3 and 5.3+3.1 (Group A), 24.7+4.2 and 4.8+4.1 (Group B) , 24.3+3.9 and 5.1+3.6 (Group C). 10 years after treatment , 21/32 (Group A) 9/36 (Group B) and 7/31 (Group C) eyes were still untreated (unpaired Student t test: p < 0.001 Group A vs B/C, p > 0.4 Group B vs C). Mean time to medication (yrs) was 6.2 (A), 3.2 (B) and 2.8 (C).

Conclusions : An SLT low-power treatment / re-treatment schedule, timed yearly, performed better than both a conventional SLT PRN schedule and an ALT in (a) delaying the need for medications and (b) medication requirement to control IOP in OAG eyes

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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