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Clayton Kirk, Junping Li, Christopher Johnson; Evaluating the efficacy of selective laser trabeculoplasty in patients who underwent prior intraocular pressure reducing procedures. Invest. Ophthalmol. Vis. Sci. 2018;59(9):6096.
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© ARVO (1962-2015); The Authors (2016-present)
Selective laser trabeculoplasty (SLT) is a proven and effective method for treatment of open angle glaucoma and ocular hypertension. In a retrospective, observational study, we evaluate the treatment response to SLT therapy in a population of Veteran patients who had previously undergone intraocular pressure (IOP) lowering procedures.
Glaucoma patients who received SLT therapy from the Edward Hines Jr. VA ophthalmology clinic were identified for the study. Of these patients, those who underwent an IOP reducing procedure were identified. These included argon laser trabeculoplasty (ALT), minimally invasive glaucoma surgery (MIGS), trabeculectomy (trab), drainage tube placement (tube), and SLT. Inclusion criteria was defined as patients who underwent an IOP reducing procedure followed by SLT therapy and adequate follow-up. Exclusion criteria were defined as patients requiring escalating medical or surgical therapy following SLT. Pre-SLT IOP measurements and previous IOP reducing procedures were recorded. Post-SLT IOP values were recorded at 1 week, 1, 3, 6, and 12 months following SLT. Data was analyzed and statistical significance was calculated using Student’s T-test. Statistical significance was defined as p ≤ 0.05.
Included in this study were 311 eyes from 215 patients that were treated with SLT therapy (SLT2). Of these, 27 underwent ALT; 16 underwent incisional surgery (MIGS/trab/tube); and 51 underwent prior SLT treatment (SLT1). Success of SLT2 was defined as ≥20% decrease in IOP, 1 year after SLT2. Relative to mean baseline measurements, a 22.0% (SD 17.46%) decrease was observed in the ALT group (p < 0.01); a 28.9% (SD 15.38%) decrease was observed in the MIGS/trab/tube group (p < 0.01); and a 15.8% (SD 15.37%) decrease was observed in the SLT1 group (p < 0.01). Success rate was found to be highest in previous incisional surgery (66.7%), followed by ALT (47.1%) and SLT1 (43.8%).
According to this study, SLT effectively reduces IOP in patients who have undergone previous IOP lowering procedures. This outcome was especially evident our previous incisional surgery group, with a success rate exceeding that found in the literature. While a decrease in IOP was observed in our SLT1 group, SLT2 was shown to be not as effective compared to SLT2 in post-MIGS/trab/tube or post-ALT 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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