Abstract
Purpose :
While the outcomes of trabecular stents (TS) post-Selective Laser Trabeculoplasty (SLT) are still debated, no research has addressed the outcomes of TS following Argon Laser Trabeculoplasty (ALT).1-3 This study evaluates the impact of Laser Trabeculoplasty (LTP) on outcomes of TS with phacoemulsification in open angle glaucoma patients.
Methods :
A retrospective analysis was performed on glaucoma patients who had iStent or Hydrus microstent with cataract surgery, grouped by laser-naive or prior LTP (SLT or ALT). Eyes with any other prior glaucoma procedures were excluded and both successful and unsuccessful LTP were included. LTP success meant achieving target intraocular pressure (IOP) at 2 months post-laser without additional medication. The primary outcome was surgical success, defined as attaining the target IOP at 12-month without additional medication or glaucoma procedure, including repeat LTP. Eyes were matched (1:3) based on age, race, sex, glaucoma type and severity, baseline IOP and number of medications. Statistical analysis included ANOVA, chi-squared, and regression modeling.
Results :
In our 220-eye cohort, 163 were laser-naive and 57 had prior LTP (35 SLT, 25 ALT). The SLT group had more preoperative medications than the laser-naïve or ALT group (p<0.05). One-year mean IOP reductions post-TS were 2.50 mmHg ± 5.1 (9.78% reduction; p<0.05) for laser-naïve, 2.69 mmHg ± 7.69 (8.91% reduction; p>0.05) for SLT, and 3.73 mmHg ± 5.40 (15.8% reduction; p<0.05) (p > 0.05 between groups). Mean medications at one year were 1.02 ± 1.23 (39.9% reduction; p<0.05) for laser-naïve, 1.57 ± 1.38 (35.5% reduction; p<0.05) for SLT, and 1.14 ± 1.32 (15.5% reduction; p>0.05) for ALT (P < 0.05 for laser-naïve vs ALT). Regression showed prior ALT (OR 1.27, p>0.05) or SLT (OR 0.733, p>0.05) did not impact TS surgery success, irrespective of LTP success or failure.
Conclusions :
Prior LTP, including SLT and ALT, does not adversely affect the outcomes of TS with phacoemulsification in open angle glaucoma patients. While our results indicate a non-harmful relationship between LTP and TS, the retrospective design and limited number of cases warrant further research.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.