Abstract
Purpose :
Selective laser trabeculoplasty (SLT) is a treatment used to lower intraocular pressure (IOP) in primary open angle glaucoma (POAG) and ocular hypertension (OHTN). The 2019 Steroids After Laser Trabeculoplasty (SALT) trial determined that non-steroidal anti-inflammatory drugs (NSAIDs) post-SLT had additional IOP-lowering effects. This study investigates whether NSAID use post-SLT has an additional IOP-lowering effect in a real-life setting outside of a controlled clinical trial.
Methods :
Retrospective chart review was performed on patients who received SLT in New York-based clinics from 2016-2021. Inclusion criteria were patients over age 18 with a minimum SLT energy of 70 mJ who received either post-SLT ketorolac (0.5%) 4 times per day for 4 days or no topical anti-inflammatory agent. Baseline, 6-, and 12-week IOPs (Goldman applanation) were recorded. Patients with glaucoma from traumatic, congenital, juvenile-onset, or multi-mechanism causes were excluded. Primary outcome was IOP reduction in NSAID vs. non-NSAID patients at the 12-week post-SLT follow up. The sample size required for an 80% chance to find differences in IOP of at least 2 mmHg was 29 in each group (α=0.05). One-way MANOVA analyses controlling for age, sex, SLT energy, and SLT degree were performed.
Results :
94 patients were included (68.8±11.9 years old, 52.1% female, Table 1). 39(41.5%) of the patients received ketorolac post-SLT. Mean cup-to-disc ratio was 0.74±0.15 and showed no differences in control vs. NSAID groups (p=0.10). 63.8% of patients had POAG, 4.3% pseudoexfoliative glaucoma, 3.2% OHTN, 11.7% normal tension glaucoma, and 17.0% had other glaucoma diagnoses. One-way MANOVA showed no differences between the groups for baseline IOP (19.3±4.0 vs. 19.4±4.2 mmHg, p=0.99, Figure 1), 6-week IOP difference (-3.1±3.8 vs. -3.6±6.3 mmHg, p=0.23), or 12-week IOP difference (-3.5±4.7 vs. -3.3±6.0 mmHg, p=0.42). No significant differences were seen in 12-week IOP difference in both baseline IOP > 21 mmHg (-6.8±4.2 vs. -8.5±5.7 mmHg, p=0.12) and IOP ≤ 21 mmHg patients (-1.9±4.1 vs. -1.0±4.5 mmHg, p=0.42).
Conclusions :
Patients who received post-SLT ketorolac did not show a difference in IOP reduction at both 6- or 12-week follow ups compared to patients who did not receive post-SLT ketorolac. Further studies are needed to determine the IOP-lowering effects of post-SLT anti-inflammatory medication.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.