Outcomes of selective laser trabeculoplasty after prior incisional surgery for open-angle glaucoma

Abstract

Purpose : Selective laser trabeculoplasty (SLT) is a commonly used office procedure to reduce IOP in patients with open-angle glaucoma. It is frequently used early in the disease course as primary therapy or after failure of medical therapy, but outcomes of SLT after previous incisional glaucoma surgery have not been well studied. The purpose of this study was to determine the efficacy and safety of SLT after prior incisional glaucoma surgery.

Methods : A retrospective chart review of all patients who underwent SLT by 3 glaucoma specialists (CS, MRM, MJP) at Wills Eye Hospital from 2014 to 2018 was performed. Patients were included if they were diagnosed with open-angle glaucoma, had an incisional glaucoma surgery prior to their SLT and had follow up of at least 3 months after SLT.

Results : A total of 39 eyes of 34 patients were included in the study. The mean age was 77 ± 10 and 17 (50%) were female. There were 30 eyes (77%) with primary open-angle glaucoma, 6 eyes (15%) with pseudoexfoliation glaucoma and 3 eyes (8%) with pigmentary glaucoma. For prior incisional glaucoma surgery, 22 (56%) had trabeculectomy, 16 (41%) had a tube shunt implant and 1 (3%) had an Ex-PRESS shunt. The mean baseline intraocular pressure (IOP) was 19.8 ± 4.7mmHg on 2.4 ± 1.0 glaucoma medications. SLT treatment was applied for an average of 95 ± 9.6 shots for 270 to 360 degrees. The mean total SLT energy was 55.7 ± 27.0 mJ. The mean follow-up time was 10.0 ± 3.3 months. At final follow-up, the mean IOP was 16.7 ± 4.9 mmHg (P = 0.002) on 1.9 ± 1.1 glaucoma medications (P = 0.04). There were no post-SLT IOP spikes or persistent inflammation after SLT treatment.

Conclusions : SLT is effective and safe in lowering IOP after prior incisional glaucoma surgery in the short and intermediate-term.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.