Abstract
Purpose :
Studies have shown the efficacy of selective laser trabeculoplasty (SLT) to lower intraocular pressure (IOP) as adjuvant therapy during short-term follow-up; however, few studies have assessed the long-term efficacy of SLT on preventing worsening visual fields and thinning of retinal nerve fiber layer (RNFL) with continued medical therapy. We examined IOP, visual field parameters, and RNFL thickness at 3- and 5-yrs post-SLT.
Methods :
A retrospective chart review was performed of 51 eyes of 39 patients with glaucoma treated with SLT at Boston Medical Center between 2012 – 2016 with subsequent follow-up with Humphrey visual field (HVF) and optical coherence tomography (OCT) exams. Outcome measures included IOP, visual acuity, number of glaucoma medications, number of months to subsequent surgical intervention. HVF outcomes included mean deviation (MD) and pattern standard deviation (PSD). OCT outcomes included RNFL mean thickness, and superior and inferior quadrant thickness.
Results :
Twenty-five eyes required subsequent surgical intervention to control IOP (mean time to intervention = 33.6 ± 20.0 months) within the follow-up period. In 26 of 51 eyes, IOP was controlled at 5-yrs after SLT. In this group, mean IOP was significantly decreased by 3 mmHg and 3.5 mmHg at 3- and 5-yrs after SLT, respectively. Mean number of glaucoma medications was significantly increased at 5-yrs (2.8 ± 1.6; P = 0.02), compared to pre-SLT (2.1 ± 1.1). Mean HVF MD was significantly higher at 5-yrs (-8.07 ± 7.15 dB) compared to pre-SLT (-5.85 ± 4.04 dB). Mean PSD significantly increased at 3-yrs (5.38 ± 2.94 dB) and 5-yrs (6.76 ± 2.79 dB), compared to pre-SLT (4.78 ± 2.93 dB; P = 0.04 and ≤ 0.01, respectively). Inferior quadrant RFNL thickness decreased significantly at 5-yrs (91.1 ± 20.8 µm), compared to pre-SLT (95.4 ± 23.0 µm).
Conclusions :
Overall, 51% of eyes had IOP controlled at 5-yr post-SLT with continued medical therapy; however, mean number of glaucoma medications was significantly higher. Also, there was progression of MD and PSD on HVF and inferior quadrant thinning on OCT at 5-yr follow-up. Our findings suggest that SLT may have some long-term benefit in controlling IOP with continued medical therapy. However, a significant number of patients required subsequent laser/surgical procedure to lower IOP, prevent worsening visual fields, and thinning of RFNL.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.