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Tony Realini, Hazel Shillingford-Ricketts, Darra Burt, Balasubramani K Goundappa; Selective Laser Trabeculoplasty in the Caribbean: 7 Years’ Experience. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3490.
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To characterize long-term clinical outcomes of Afro-Caribbean adults with primary open-angle glaucoma (POAG) undergoing selective laser trabeculoplasty (SLT) as sole therapy.
Data from 242 eyes of 121 subjects from Saint Lucia and Dominica in 2 prospective SLT study cohorts with harmonized eligibility criteria and protocols were pooled. One launched in 2010 and was not required to register under then-current rules; the second launched in 2015 and was registered following the 2014 rule revision (NCT 02375009). Subjects underwent washout of any intraocular pressure (IOP)-lowering medications, baseline IOP assessment, and bilateral 360-degree SLT. Follow-up was every 3-4 months for up to 7.7 years. Repeat SLT was performed according to prespecified retreatment criteria. Mean IOP and changes from baseline were calculated in 1-year increments (each increment representing the mean of all measurements within the specified time frame). Survival analysis was performed to assess achievement and maintenance of a minimum 20% IOP reduction from baseline with one or more SLT treatments and no other treatment (medication or surgery). Right and left eyes were assessed separately. Right eye data are presented here (left eye data were similar).
Mean (standard error) follow-up was 54.2 (2.6) months. Mean baseline IOP was 21.2 (0.3) mmHg. A mean of 1.4 SLT treatments per eye was performed. At 1, 2, 3, 4, 5, 6, and 7+ years after initial SLT (with repeat SLT performed as needed), mean IOP was 13.8 (0.3) (n=120), 14.7 (0.3) (n=1-9), 14.7 (0.3) (n=96), 14.2 (0.3) (n=71), 13.0 (0.4) (n=47), 14.6 (0.5) (n=45), and 15.7 (0.4) (n=43) mmHg, respectively representing reductions ranging from 5.8-8.6 mmHg (26-39%) (p<0.0001 at each time point). Medication-free survival rates for a treatment regimen of SLT repeated as needed at 1, 3, 5, and 7 years were 96%, 82%, 79%, and 76%, respectively. Common postoperative adverse events included photophobia, eye pain, and redness, were mild to moderate in severity, and resolved spontaneously in almost all cases.
SLT, repeated as needed, provides statistically and clinically significant IOP reductions that endure through up to 7.7 years of follow-up. This treatment modality is a viable alternative to medical therapy and may prevent glaucoma progression and vision loss in people of African descent.
This is a 2020 ARVO Annual Meeting abstract.
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