Abstract
Purpose :
Selective laser trabeculoplasty (SLT) is often used as primary or adjunct therapy for glaucoma, however, the outcomes of SLT after prior incisional glaucoma surgery (Trabeculectomy or Tube Shunts) have been understudied. This study investigates the effectiveness of SLT in patients with a history of such surgeries.
Methods :
A retrospective chart review of all patients who underwent SLT at The George Washington University Medical Faculty Associates from 2018 to 2022 was performed. Patients were included if they were diagnosed with primary open-angle glaucoma, had an incisional glaucoma surgery prior to their SLT and had follow-up of at least 12 months after SLT. The primary outcome was SLT success, defined as IOP reduction of 20% or greater without the use of additional glaucoma medications compared to pre-SLT IOP. Eyes were matched (1:3) on baseline demographics, IOP, and number of medications. Analysis included chi-squared tests, t-tests, and regression modeling.
Results :
There were 22 eyes with surgery (study) and 66 eyes without surgery (control) prior to SLT, with a mean age of 72.9 ± 11.2. In the study group, 17 out of 22 eyes had not undergone prior laser treatment, while all 66 eyes in the control group were laser-naive. Baseline IOP and ocular medications in the study group changed from 16.2 ± 3.3 mmHg on 2.2 ± 1.2 medications to 14.9 ± 3.9 mm Hg (8.1% reduction; p>0.05) on 3.5 ± 1.0 medications (4.1% increase; p>0.05) at 1 year. In the control group, baseline IOP and ocular medications changed from 16.3 ± 4.0 mmHg on 2.2 ± 1.2 medications to 13.6 ± 3.3 mm Hg (16.8% reduction; p<0.001) on 2.9 ± 1.0 medications (4.9% reduction; p>0.05) at 1 year. There was no difference in IOP reduction or change in the number of glaucoma medications after SLT at 6 weeks, 6 months, and 1 year between both groups (p>0.05). Primary success rates at 1 year was 40.9% for the control group and 18.2% for the study group (P>0.05 between groups). Prior laser or incisional surgery were not associated with or predictive of treatment outcomes (p>0.05). One eye in the study group received a repeat SLT within 12 months. There were no adverse events.
Conclusions :
SLT shows reduced efficacy in lowering IOP in eyes with previous incisional glaucoma surgery compared to those without such history. A long-term randomized controlled trial is warranted to validate these findings.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.