Abstract
BackgroundTo analyze the results of repeat selective laser trabeculoplasty (SLT).MethodsInclusion criteria: participants with primary or secondary open-angle glaucoma (excluding uveitic) who had undergone SLT 360° (SLT 1) with diminution of response over time followed by repeat SLT 360° (SLT 2). Six months of follow-up were required and at least 6 months in between SLT 1 and 2. The main outcome measures were IOP reduction at 6 and 12 months and a comparison of the response between SLT 1 and 2.ResultsOne hundred thirty-seven patients met the inclusion criteria. If only one eye had repeat treatment, that eye was chosen; if both eyes qualified, one was chosen at random. The baseline intraocular pressure (IOP) for SLT 1 = 20.3+/− 5.2 mmHg and SLT 2 = 19.4 +/− 5.0 was reduced to 16.4 +/− 3.9 and 16.7 +/− 4.7 at 1 year, respectively (p < .001). Medication use was not significantly changed, and was 2.2 +/− 1.2 at baseline for SLT 1 and 2.1 +/− 1.3 for SLT 2, and at 1 year was 1.9 +/− 1.3 and 2.2 +/− 1.2, respectively. A subanalysis of 62 patients matched for equivalent baselines showed a baseline IOP = 18.7 +/− 3.8 for SLT 1 and 18.7 +/− 3.5 for SLT 2, reduced to 16.0 +/− 4.3 and 15.3 +/− 3.8 at 1 year (p < .001).ConclusionRepeat SLT laser (360-degree treatment, followed by a loss of effect over time, then a second 360-degree treatment) in this population resulted in IOP lowering similar to that of the initial treatment.
Highlights
To analyze the results of repeat selective laser trabeculoplasty (SLT)
argon laser trabeculoplasty (ALT) produces significant tissue disruption and coagulative damage to the trabecular meshwork, possibly contributing to the limited success rates reported after retreatment [5, 6]
The sequential treatment group (ALT SLT) had a mean intraocular pressure (IOP) reduction of 3.8 mmHg from a baseline of 25.3 mmHg, which was comparable to the group without any prior laser treatment
Summary
Laser trabeculoplasty has been employed as initial, adjunct or replacement therapy to lower intraocular pressure (IOP) in patients with open-angle glaucoma (OAG). Laser trabeculoplasty has been used to successfully lower the IOP and slow visual field progression in several multicenter randomized trials, notably the Early Manifest Glaucoma Trial [1] and the Advanced Glaucoma Intervention Study [2]. The Glaucoma Laser Trial showed that in patients with newly diagnosed open-angle glaucoma, argon laser trabeculoplasty (ALT) was at least as effective as initial treatment with timolol maleate 0.5 %, even after. Repeated treatment of the angle with argon laser will eventually lead to synechial angle closure and a decrease in outflow facility. This, coupled with the fact that most patients eventually ended up on medications, led to the failure of acceptance of ALT as primary glaucoma therapy. Most physicians in the United States maintained the algorithm of maximum tolerated medications first, laser trabeculoplasty, and filtration surgery
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