Comparison of Treatment Outcomes of Selective Laser Trabeculoplasty for Primary Open-Angle Glaucoma and Pseudophakic Primary Angle-Closure Glaucoma Receiving Maximal Medical Therapy.

Jia-Kang Wang,Pei-Yao Chang,Tzu-Lun Huang,Jiun-Yi Wang,Yung-Ray Hsu

doi:10.3390/jcm10132853

Abstract

Selective laser trabeculoplasty (SLT) is a useful treatment for intraocular pressure (IOP) control. However, there are only a few reports which compare the outcomes of SLT between primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). We compared the efficacy of SLT for patients with PACG following phacoemulsification with POAG receiving maximal medical therapy (MMT). Consecutive glaucoma patients followed up for at least 1 year after SLT were retrospectively evaluated and IOP reductions at 6 months and 12 months were analyzed. Seventy-six patients were included in the analyses. The baseline IOPs in the POAG and PACG group were 18.5 ± 3.3 mmHg and 16.9 ± 2.5 mmHg, respectively, with 2.8 ± 0.9 and 2.7 ± 0.8 types of IOP lowering medication. The average IOP at the 6-month and 12-month follow-up after SLT was significantly decreased and comparable in both the POAG and PACG groups. For those with a low baseline IOP, the effect of SLT on IOP reduction at 12 months was significantly better in the PACG than in the POAG group (p = 0.003). IOP reduction at 6 and 12 months after SLT was significantly greater in those with a high baseline IOP than those with a low baseline IOP (p < 0.0065). In summary, the one-year efficacy of SLT was equivalent in POAG and pseudophakic PACG patients receiving MMT; however, SLT was more effective in eyes with PACG than eyes with POAG when focusing on those with a lower baseline IOP.

Highlights

Intraocular pressure (IOP) control is currently the only well-established treatment for glaucoma to slow or prevent further visual field progression
Studies comparing the effectiveness of Selective laser trabeculoplasty (SLT) in Primary angle closure glaucoma (PACG) and primary open angle glaucoma (POAG) are inconclusive and the data regarding the efficacy in PACG eyes is rather limited
One thing in their study that needs to be addressed was that the percentage of 360-degree of SLT application and the laser energy was significantly higher in their POAG group, while the success rate was 84% in the PACG and 79% in the POAG group

Summary

Introduction

Intraocular pressure (IOP) control is currently the only well-established treatment for glaucoma to slow or prevent further visual field progression. Selective laser trabeculoplasty (SLT) is an efficient IOP-lowering treatment for primary open angle glaucoma (POAG) and ocular hypertension [1,2]. Studies have proved that SLT can be used as an initial treatment or in combination with IOP-lowing drugs when the topical medications could not obtain satisfactory therapeutic effects in patients with POAG [1,3,4,5]. Laser peripheral iridotomy (LPI) is the current first-line treatment in the management of PACG and argon laser peripheral iridoplasty has been shown to dramatically lower the IOP and open up the closed angles [6]. Medical therapy is often required after LPI for IOP control [7]

Methods

Results

Conclusion