Abstract
Purpose To compare the ability of SLT in preventing glaucoma progression in the initial primary angle-closure glaucoma (PACG) after laser peripheral iridotomy and primary open-angle glaucoma (POAG) in the long term. Methods 60 patients with the initial stage of PACG after laser peripheral iridotomy and 64 initial POAG patients were recruited in a prospective study. Complete success of selective laser trabeculoplasty (SLT) was defined as a 20% intraocular pressure (IOP) reduction with topical hypotensive medications without any hypotensive intervention. Pre-SLT rate of progression and post-SLT rate of progression (ROP) was detected in the both groups by means of the trend and the event analysis of perimetry, the Guided Progression Analysis, and the optical coherence tomography- (OCT-) based negative trend for either the thickness of the peripapillary retinal nerve fiber layer (RNFL) or ganglion cell complex (GCC). Results IOP decreased significantly after SLT in both the groups. 30% in PACG and 19% in POAG had the progression according to perimetry and 49% in PACG and 40% in POAG had the progression, respectively, according to OCT. After SLT, ROP was reduced from −0.14 ± 0.39 dB/year to −0.08 ± 0.48 dB/year, p=0.034, in PACG and from −0.09 ± 0.36 dB/year to −0.04 ± 0.43 dB/year, p=0.021, in POAG. According to RNFL trend analysis, ROP was reduced from −1.86 ± 2.9 μm/year to −1.38 ± 2.2 μm/year, p=0.039, and from −1.24 ± 2.23 μm/year to −0.76 ± 1.73 μm/year, p=0.037, in PACG and POAG, and according to GCC, ROP was reduced from −1.88 ± 2.9 μm/year to −1.34 ± 2.0 μm/year, p=0.040, and from −1.35 ± 2.16 μm/year to −0.91 ± 1.86 μm/year, p=0.040, in PACG and POAG, respectively. ROP was significantly faster in PACD than in POAG between 2 and 6 years after SLT: −0.15 ± 0.46 dB/year and 0.02 ± 0.38 dB/year (p=0.042). However, it did not differ significantly according to OCT. Conclusion SLT is an effective treatment for initial PACG after LPI and POAG that can prevent functional and structural deterioration in the long term.
Highlights
Primary angle-closure glaucoma (PACG) is one of the most severe forms of glaucoma. 16 million people suffer from PACG worldwide [1]
We revealed that “the oneyear efficacy of selective laser trabeculoplasty (SLT) in primary open-angle glaucoma (POAG) and PACG after laser peripheral iridotomy (LPI) was high, but it was reduced in the long-term period”
Results e present analysis included 62 out of 120 total initial PACG eyes and 64 out of 120 total initial POAG eyes after applying the minimum complete follow-up visit requirements and after excluding 17 PACG eyes and 11 POAG eyes showing significant cataract progression. e follow-up period amounted to 40.67 ± 1.43 months for PACG eyes before SLT and 39.49 ± 20.48 after SLT and 37.29 ± 19.13 months before SLT and 42.68 ± 21.18 after SLT for POAG eyes
Summary
Primary angle-closure glaucoma (PACG) is one of the most severe forms of glaucoma. 16 million people suffer from PACG worldwide [1]. 16 million people suffer from PACG worldwide [1] It progresses faster than primary open-angle glaucoma (POAG) [2] with a rapid progression in more than 57% of patients [3]. E current mostly used treatment for this form of glaucoma is laser peripheral iridotomy (LPI) [5, 6]. SLT is the most common method of laser treatment of primary openangle glaucoma (POAG) [12, 13]. We have demonstrated the efficacy of SLT for patients with PACG following a YAG laser peripheral iridotomy (PI) and studied the predictors of its outcome [14]. E purpose of this study is to assess the ability of SLT in preventing glaucoma progression in PACG in the long-term and to compare it with the primary POAG
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